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Sample records for mesenquimal sinonasal grado

  1. [Sinonasal adenocarcinomas: our experience].

    PubMed

    Llorente, José Luis; Núñez, Faustino; Rodrigo, Juan Pablo; Fernández León, Ramón; Alvarez, César; Hermsen, Mario; Suárez, Carlos

    2008-05-01

    Sinonasal adenocarcinoma is a rare epithelial cancer of the nasal cavities and paranasal sinuses and exposure to sawdust particles is a strong aetiological factor. Seventy-nine patients (78 men and 1 woman) operated on between 1986 and 2002 were studied. In 62 patients (78.5 %) there was a history of exposure to wood dust. The clinical factors presenting statistical significance in the multivariate analysis with prognosis were: the exclusive invasion of the middle concha (as good prognosis), recurrence and invasion of the dura mater (as bad prognosis). The actuarial survival rate was 36 % at 5 years falling to 28 % at 10 years. Exposure to wood dust, even over a short period of time, must be considered as a high risk factor for the development of a sinonasal adenocarcinoma. This tumour must be ruled out in all patients suffering any type of sinonasal pathology.

  2. Radiological sinonasal anatomy

    PubMed Central

    Alrumaih, Redha A.; Ashoor, Mona M.; Obidan, Ahmed A.; Al-Khater, Khulood M.; Al-Jubran, Saeed A.

    2016-01-01

    Objectives: To assess the prevalence of common radiological variants of sinonasal anatomy among Saudi population and compare it with the reported prevalence of these variants in other ethnic and population groups. Methods: This is a retrospective cross-sectional study of 121 computerized tomography scans of the nose and paranasal sinuses of patients presented with sinonasal symptoms to the Department of Otorhinolarngology, King Fahad Hospital of the University, Khobar, Saudi Arabia, between January 2014 and May 2014. Results: Scans of 121 patients fulfilled inclusion criteria were reviewed. Concha bullosa was found in 55.4%, Haller cell in 39.7%, and Onodi cell in 28.9%. Dehiscence of the internal carotid artery was found in 1.65%. Type-1 and type-2 optic nerve were the prevalent types. Type-II Keros classification of the depth of olfactory fossa was the most common among the sample (52.9%). Frontal cells were found in 79.3%; type I was the most common. Conclusions: There is a difference in the prevalence of some radiological variants of the sinonasal anatomy between Saudi population and other study groups. Surgeon must pay special attention in the preoperative assessment of patients with sinonasal pathology to avoid undesirable complications. PMID:27146614

  3. Sinonasal and laryngeal sarcoidosis.

    PubMed

    Edriss, Hawa; Kelley, John; Demke, Joshua

    2017-10-01

    Sarcoidosis is a chronic granulomatous inflammation of uncertain etiology that can involve any organ system in the body. Sinonasal and laryngeal involvement is rare, poorly understood, and difficult to diagnose. Additionally, the extent of the disease is variable, and the response to systemic corticosteroids is often poor. We report a case of a 55-year-old woman with prior cutaneous sarcoidosis who presented with chronic nasal congestion, difficulty breathing, dysphonia, and stridor, and biopsy of the nasal vestibule revealed noncaseating granulomatous inflammation.

  4. Intensity-Modulated or Proton Radiation Therapy for Sinonasal Malignancy

    ClinicalTrials.gov

    2017-01-26

    Adenoid Cystic Carcinoma; Squamous Cell Carcinoma; Sinonasal Carcinoma; Sinonasal Undifferentiated Carcinoma; Mucoepidermoid Carcinoma; Schneiderian Carcinoma; Myoepithelial Carcinoma; Esthesioneuroblastoma; Melanoma

  5. Aggressive necrotizing pseudomonal sinonasal infections.

    PubMed

    Kuan, Edward C; Tajudeen, Bobby A; Welch, Kevin C; Chandra, Rakesh K; Glasgow, Ben J; Suh, Jeffrey D

    2017-09-01

    Pseudomonas aeruginosa is a gram-negative bacterium frequently implicated in recalcitrant sinonasal infections, especially in immunocompromised hosts. We report 6 cases of rapidly progressive pseudomonal acute rhinosinusitis producing tissue necrosis and, in certain cases, cranial nerve palsies. Retrospective review of 6 patients with aggressive necrotizing sinonasal infections treated at 4 tertiary academic medical centers with sinonasal cultures growing P. aeruginosa in the absence of other pathology. A total of 6 patients were identified. In all cases, there was tissue necrosis that appeared to mimic an invasive process such as mucormycosis, prompting urgent surgical intervention. Pathologic analysis revealed fibropurulent exudates in backgrounds of positive P. aeruginosa cultures without evidence of invasive fungal organisms or malignancy. Four of the 6 patients presented with cranial nerve palsies, with 3 patients having vision changes and 3 complaining of trigeminal neuropathy. Four of 6 patients improved clinically over time after surgery and antibiotic therapy; 1 remains in follow-up without complete improvement and 1 has succumbed to other causes. P. aeruginosa is a tenacious organism that is frequently associated with severe, recalcitrant sinonasal infections. We report the first case series of necrotizing sinonasal infections caused by this organism, and illustrate that, in rare cases, P. aeruginosa may mimic and behave like life-threatening conditions such as fulminant invasive fungal sinusitis or malignancy. © 2017 ARS-AAOA, LLC.

  6. Recently described neoplasms of the sinonasal tract.

    PubMed

    Bishop, Justin A

    2016-03-01

    Surgical pathology of the sinonasal region (i.e., nasal cavity and the paranasal sinuses) is notoriously difficult, due in part to the remarkable diversity of neoplasms that may be encountered in this area. In addition, a number of neoplasms have been only recently described in the sinonasal tract, further compounding the difficulty for pathologists who are not yet familiar with them. This manuscript will review the clinicopathologic features of some of the recently described sinonasal tumor types: NUT midline carcinoma, HPV-related carcinoma with adenoid cystic-like features, SMARCB1 (INI-1) deficient sinonasal carcinoma, biphenotypic sinonasal sarcoma, and adamantinoma-like Ewing family tumor.

  7. Current Trends in Sinonasal Imaging.

    PubMed

    Huang, Benjamin Y; Senior, Brent A; Castillo, Mauricio

    2015-11-01

    As endoscopic sinus surgery (ESS) has evolved since its introduction to the United States, so has technology for imaging the sinonasal cavities. Although imaging is most frequently performed for evaluating chronic sinusitis refractory to medical therapy, its uses have expanded beyond inflammatory sinus disease. Multidetector Computed Tomography is the current workhorse for both diagnosis and preoperative planning in prospective ESS patients, while MR imaging remains a complementary tool for evaluating suspected tumors or intracranial and orbital complications of rhinosinusitis. In this article, the authors review current trends and potential future directions in the use of these modalities for sinus imaging.

  8. Association between septal deviation and sinonasal papilloma.

    PubMed

    Nomura, Kazuhiro; Ogawa, Takenori; Sugawara, Mitsuru; Honkura, Yohei; Oshima, Hidetoshi; Arakawa, Kazuya; Oshima, Takeshi; Katori, Yukio

    2013-12-01

    Sinonasal papilloma is a common benign epithelial tumor of the sinonasal tract and accounts for 0.5% to 4% of all nasal tumors. The etiology of sinonasal papilloma remains unclear, although human papilloma virus has been proposed as a major risk factor. Other etiological factors, such as anatomical variations of the nasal cavity, may be related to the pathogenesis of sinonasal papilloma, because deviated nasal septum is seen in patients with chronic rhinosinusitis. We, therefore, investigated the involvement of deviated nasal septum in the development of sinonasal papilloma. Preoperative computed tomography or magnetic resonance imaging findings of 83 patients with sinonasal papilloma were evaluated retrospectively. The side of papilloma and the direction of septal deviation showed a significant correlation. Septum deviated to the intact side in 51 of 83 patients (61.4%) and to the affected side in 18 of 83 patients (21.7%). Straight or S-shaped septum was observed in 14 of 83 patients (16.9%). Even after excluding 27 patients who underwent revision surgery and 15 patients in whom the papilloma touched the concave portion of the nasal septum, the concave side of septal deviation was associated with the development of sinonasal papilloma (p = 0.040). The high incidence of sinonasal papilloma in the concave side may reflect the consequences of the traumatic effects caused by wall shear stress of the high-velocity airflow and the increased chance of inhaling viruses and pollutants. The present study supports the causative role of human papilloma virus and toxic chemicals in the occurrence of sinonasal papilloma.

  9. Sinonasal inverted papilloma: From diagnosis to treatment.

    PubMed

    Lisan, Q; Laccourreye, O; Bonfils, P

    2016-11-01

    Inverted papilloma is a rare sinonasal tumor that mainly occurs in adults during the 5th decade. Three characteristics make this tumor very different from other sinonasal tumors: a relatively strong potential for local destruction, high rate of recurrence, and a risk of carcinomatous evolution. Etiology remains little understood, but an association with human papilloma virus has been reported in up to 40% of cases, raising the suspicions of implication in the pathogenesis of inverted papilloma. Treatment of choice is surgery, by endonasal endoscopic or external approach, depending on extension and tumoral characteristics. Follow-up is critical, to diagnose local relapse, which is often early but may also be late. The seriousness of this pathology lies in its association with carcinoma, which may be diagnosed at the outset or at recurrence during follow-up. It is important to diagnose recurrence to enable early treatment, especially in case of associated carcinoma or malignancy. A comprehensive review of the international literature was performed on PubMed and Embase, using the following search-terms: "sinonasal" [All Fields] AND ("papilloma, inverted" [MeSH Terms] OR ("papilloma" [All Fields] AND "inverted" [All Fields]) OR "inverted papilloma" [All Fields] OR ("inverted" [All Fields] AND "papilloma" [All Fields])). We reviewed all articles referring to sinonasal inverted papilloma published up to January 2015. The present article updates the state of knowledge regarding sinonasal inverted papilloma. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. Sinonasal polyposis: investigation by direct coronal CT.

    PubMed

    Drutman, J; Harnsberger, H R; Babbel, R W; Sonkens, J W; Braby, D

    1994-08-01

    To demonstrate the typical clinical and CT features of sinonasal polyposis, we reviewed the clinical records and preoperative direct coronal CT scans of 35 patients with surgically proven disease. Symptoms included progressive nasal stuffiness (100%), rhinorrhea (69%), facial pain (60%), headache (43%) and anosmia (17%). We found associations with rhinitis (46%), asthma (29%) and aspirin sensitivity (9%). Coronal CT features included polypoid masses in the nasal cavity (91%), partial or complete pansinus opacification (90%), enlargement of infundibula (89%), bony attenuation of the ethmoid trabeculae (63%) and nasal septum (37%), opacified ethmoid sinuses with convex lateral walls (51%) and air-fluid levels (43%). The latter feature correlated with symptoms and signs of acute sinusitis in only 40% of patients. Recognition of sinonasal polyposis is important to the endoscopic surgeon since it can be the most troubling sinonasal inflammatory disease to manage due to its aggressive nature and tendency to recur despite appropriate treatment.

  11. Sinonasal microbiome sampling: a comparison of techniques.

    PubMed

    Bassiouni, Ahmed; Cleland, Edward John; Psaltis, Alkis James; Vreugde, Sarah; Wormald, Peter-John

    2015-01-01

    The role of the sino-nasal microbiome in CRS remains unclear. We hypothesized that the bacteria within mucosal-associated biofilms may be different from the more superficial-lying, free-floating bacteria in the sinuses and that this may impact on the microbiome results obtained. This study investigates whether there is a significant difference in the microbiota of a sinonasal mucosal tissue sample versus a swab sample. Cross-sectional study with paired design. Mucosal biopsy and swab samples were obtained intra-operatively from the ethmoid sinuses of 6 patients with CRS. Extracted DNA was sequenced on a Roche-454 sequencer using 16S-rRNA gene targeted primers. Data were analyzed using QIIME 1.8 software package. At a maximum subsampling depth of 1,100 reads, the mean observed species richness was 33.3 species (30.6 for swab, versus 36 for mucosa; p > 0.05). There was no significant difference in phylogenetic and non-phylogenetic alpha diversity metrics (Faith's PD_Whole_Tree and Shannon's index) between the two sampling methods (p > 0.05). The type of sample also had no significant effect on phylogenetic and non-phylogenetic beta diversity metrics (Unifrac and Bray-Curtis; p > 0.05). We observed no significant difference between the microbiota of mucosal tissue and swab samples. This suggests that less invasive swab samples are representative of the sinonasal mucosa microbiome and can be used for future sinonasal microbiome studies.

  12. Evaluation of Sinonasal Diseases by Computed Tomography

    PubMed Central

    Phatak, Suresh

    2016-01-01

    Introduction Computed Tomography (CT) plays an important diagnostic role in patients with sinonasal diseases and determines the treatment. The CT images clearly show fine structural architecture of bony anatomy thereby determining various anatomical variation, extent of disease and characterization of various inflammatory, benign and malignant sinonasal diseases. Aim To evaluate sensitivity and specificity of CT in diagnosis of sinonasal diseases and to characterise the benign and malignant lesions with the help of various CT parameters. Also, to correlate findings of CT with histo-pathological and diagnostic nasal endoscopy/ Functional Endoscopic Sinus Surgery (FESS) findings. Materials and Methods In this hospital based prospective study 175 patients with symptomatic sinonasal diseases were evaluated by clinical diagnosis and 16 slice Multi Detector Computed Tomography (MDCT). The details of findings of nasal endoscopy, Functional Endoscopic Sinus Surgery (FESS), histopathological examination and fungal culture were collected in all those cases where those investigations were done. All those findings were correlated with CT findings and statistical analysis was done by using Test statistics (sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy), Chi-Square test and Z-test for single proportions. Software used in the analysis was SPSS 17.0 version and graph pad prism 6.0 version and p < 0.05 was considered as statistically significant. Results CT diagnosis had higher sensitivity, specificity, PPV and NPV in diagnosing various sinonasal diseases in comparison to clinical diagnosis. On correlating CT diagnosis with final diagnosis, congenital conditions have 100% sensitivity and specificity. Chronic sinusitis has 98.3% sensitivity and 97.8% specificity. For fungal sinusitis the sensitivity was 60% and specificity was 99.3%. Polyps have sensitivity of 94.4% and specificity of 98.1%. Benign neoplasms have sensitivity

  13. Primary sinonasal tuberculosis confined to the unilateral maxillary sinus.

    PubMed

    Kim, Kyung Yeon; Bae, Jung Ho; Park, Jee Soo; Lee, Seung-Sin

    2014-01-01

    Extrapulmonary tuberculosis is not rare and occurs mainly in the head and neck region. Cervical tuberculous lymphadenopathy is the most common form of extrapulmonary tuberculosis. Sinonasal tuberculosis is known to occur very rarely due to the protective functions of sinonasal mucosa. Although some signs of sinonasal tuberculosis may be present, such as associated facial abscesses, the symptoms and signs are usually nonspecific. Clinical suspicion is important for timely diagnosis and proper management of sinonasal tuberculosis due to its rarity and nonspecific clinical presentation. We report a case of tuberculosis confined to the unilateral maxillary sinus that was first misdiagnosed as recurrent rhinosinusitis after endoscopic sinus surgery.

  14. Histopathological findings in equine sinonasal disorders.

    PubMed

    Tremaine, W H; Clarke, C J; Dixon, P M

    1999-07-01

    Biopsies collected from 79 referred cases of equine sinonasal disease, including 27 horses with primary sinusitis, 10 with secondary dental sinusitis, 19 with sinus cysts, 11 with progressive ethmoid haematomata (PEH), 4 with false nostril epidermal inclusion cysts, 4 with sinonasal polyps, 3 with sinonasal mycosis and from 2 control animals were examined histologically. Observations were made on epithelial type and integrity, cellular inflammatory response, fibroplasia and presence of potential pathogens. Chronic inflammatory changes including mucosal thickening, ulceration and significant fibroplasia, were found in the sinus mucosa with most sinus disorders, similar to those found in human chronic sinusitis. Bacteria were variably present on sinusitis mucosae but their aetiological significance was unclear. The presence of apparently irreversible changes including fibroplasia in some of these sinusitis cases may explain their poor or delayed response to treatment. Sinus cysts had histological similarities to human mucocoeles. Progressive ethmoid haematomata showed recent and older haemorrhage, as did sinus cysts (and occasionally some chronic sinusitis sections), but support for a common aetiology between sinus cysts and PEH was absent.

  15. Activating KRAS mutations are characteristic of oncocytic sinonasal papilloma and associated sinonasal squamous cell carcinoma.

    PubMed

    Udager, Aaron M; McHugh, Jonathan B; Betz, Bryan L; Montone, Kathleen T; Livolsi, Virginia A; Seethala, Raja R; Yakirevich, Evgeny; Iwenofu, O Hans; Perez-Ordonez, Bayardo; DuRoss, Kathleen E; Weigelin, Helmut C; Lim, Megan S; Elenitoba-Johnson, Kojo Sj; Brown, Noah A

    2016-08-01

    Oncocytic sinonasal papillomas (OSPs) are benign tumours of the sinonasal tract, a subset of which are associated with synchronous or metachronous sinonasal squamous cell carcinoma (SNSCC). Activating EGFR mutations were recently identified in nearly 90% of inverted sinonasal papillomas (ISPs) - a related tumour with distinct morphology. EGFR mutations were, however, not found in OSP, suggesting that different molecular alterations drive the oncogenesis of these tumours. In this study, tissue from 51 cases of OSP and five cases of OSP-associated SNSCC was obtained retrospectively from six institutions. Tissue was also obtained from 50 cases of ISP, 22 cases of ISP-associated SNSCC, ten cases of exophytic sinonasal papilloma (ESP), and 19 cases of SNSCC with no known papilloma association. Using targeted next-generation and conventional Sanger sequencing, we identified KRAS mutations in 51/51 (100%) OSPs and 5/5 (100%) OSP-associated SNSCCs. The somatic nature of KRAS mutations was confirmed in a subset of cases with matched germline DNA, and four matched pairs of OSP and concurrent associated SNSCC had concordant KRAS genotypes. In contrast, KRAS mutations were present in only one (5%) SNSCC with no known papilloma association and none of the ISPs, ISP-associated SNSCCs, or ESPs. This is the first report of somatic KRAS mutations in OSP and OSP-associated SNSCC. The presence of identical mutations in OSP and concurrent associated SNSCC supports the putative role of OSP as a precursor to SNSCC, and the high frequency and specificity of KRAS mutations suggest that OSP and OSP-associated SNSCC are biologically distinct from other similar sinonasal tumours. The identification of KRAS mutations in all studied OSP cases represents an important development in our understanding of the pathogenesis of this disease and may have implications for diagnosis and therapy. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd

  16. Human sinonasal explant system for testing cytotoxicity of intranasal agents

    PubMed Central

    Lim, Jae H.; Davis, Greg E.; Rue, Tessa C.; Storm, Daniel R.

    2011-01-01

    BACKGROUND Intranasal agents play a critical role in the management of sinonasal disorders. There are ongoing efforts to develop new intranasal medications to combat sinonasal disease. Some intranasal agents, however, can have cytotoxic effects on human sinonasal tissue. In order to facilitate safe drug discovery, we developed a simple and reliable in vitro screening assay using human sinonasal explants to measure the cytotoxic profiles of intranasal agents. METHODS We obtained sinonasal tissues from several regions of the nasal cavity from 12 patients undergoing endoscopic sinonasal surgery. These tissues were cultured on polytetrafluoroethane membrane in serum free growth medium. We determined the biochemical properties of these explants by measuring extracellular lactate dehydrogenase (LDH) levels and performing histological analyses over a period of 1–2 weeks. We then examined the cytotoxic profiles of 13 intranasal agents by measuring extracellular LDH levels using the human sinonasal explant system. RESULTS Sinonasal explants exhibited a rapid reduction in extracellular LDH levels indicating stabilization in the culture environment within 2 days. Histological analysis showed maintenance of good cellular architecture for up to 2 weeks. The explants displayed intact epithelium and expressed βIII-tubulin and Ki-67. Of the 13 tested intranasal agents, 1% zinc sulfate, 5% zinc sulfate and Zicam application were cytotoxic. CONCLUSIONS Based on the unique biochemical properties of the human nasal explant culture system, we developed a simple and reliable in vitro screening assay to determine the cytotoxic profiles of various intranasal agents by examining extracellular LDH levels and histopathology. PMID:22170775

  17. Hamartomas, papillomas and adenocarcinomas of the sinonasal tract and nasopharynx.

    PubMed

    Perez-Ordoñez, B

    2009-12-01

    Lesions of the sinonasal tract are uncommon, with most of the specimens seen by surgical pathologists consisting primarily of fragments of inflamed sinonasal mucosa or inflammatory polyps from patients with chronic rhinosinusitis, and the occasional squamous cell carcinoma. Other lesions such as hamartomas, various types of Schneiderian papillomas and adenocarcinomas are seen only rarely by most histopathologists; therefore a biopsy or surgical resection specimen from a patient with one of these processes may represent a diagnostic challenge. The aim of this review is to present the pathological features of a group of infrequent epithelial surface and glandular lesions of the sinonasal tract which includes respiratory epithelial adenomatoid hamartoma, glandular (seromucinous) hamartoma, exophytic papilloma, inverted papilloma, cylindrical cell (oncocytic) papilloma, low-grade sinonasal adenocarcinoma and intestinal-type sinonasal adenocarcinoma.

  18. Sino-nasal mucosal malignant melanoma.

    PubMed

    Karim, Muneeb Uddin; Khan, Khursheed; Ali, Nasir; Ikram, Mubasher

    2015-04-29

    A 49-year-old man with a history of left nasal discharge and nasal cavity blockage for 5 months was diagnosed with sino-nasal mucosal malignant melanoma on nasal biopsy. On CT scan, the tumour involved the nasal cavity, left maxillary sinus, ethmoid sinus and medial left orbit. The tumour was grossly excised and adjuvant radiation therapy was offered. The patient was planned for an Intensity Modulated Radiotherapy technique to keep tolerance doses of organs at risk within normal limits and at same time deliver the intended dose of radiation to the tumour site, using 66 Gy in 33 fractions. Owing to the anatomical complexity of the sino-nasal region, precision radiotherapy (RT) is mandatory to optimally irradiate the tumour area while sparing critical surrounding normal structures from late toxicity of RT. Established dose constraints for at-risk organs can only be accomplished through this novel technique of RT. However, despite advances in techniques, current treatment modalities have not significantly made an impact on survival of these patients. 2015 BMJ Publishing Group Ltd.

  19. Sinonasal papilloma in Chiang Mai University Hospital.

    PubMed

    Fooanant, Supranee; Pattarasakulchai, Thienchai; Tananuvat, Rak; Sittitrai, Pichit; Chaiyasate, Saisawat; Roongrotwattanasiri, Kannika; Srivanitchapoom, Chonticha

    2013-03-01

    To study sinonasal papilloma patients in terms of clinical characteristics, treatment, outcome, and complications. A retrospective descriptive study was done. Sinonasalpapilloma data were gathered between 1999 and 2009. There were 63 available patients from the 82 cases. There were nine cases of nasal papilloma (14.3%) and 54 of inverted papilloma (85.7%). The mean age of the inverted papilloma group was higher than the nasal papilloma group (54 +/- 12.97 years vs. 42.4 +/- 24.8 years). The most common symptom was unilateral nasal obstruction. There were three cases of synchronous malignancy in the inverted papilloma and two metachronous (9.3%). Thirty-nine patients (72%) could be followed-up for more than three months. Recurrence was more common in the inverted papilloma group than nasal papilloma (37% vs. 11.1%). The 50% recurrent time of the endoscopic group was 51 weeks and the external group was 14 weeks. The recurrence of the external approach group was 1.59 times the endoscopic group. Ten surgical complications were found in eight inverted papilloma patients (16%) and included three in the endoscopic and five in the external group. Most of them were minor They were hypoesthesia and epiphora. Sinonasal inverted papilloma was common, able to recur and associated with malignancy. Though this was a limited retrospective study, it showed lower recurrence on the endoscopic approach. The life-long follow-up is needed in all cases.

  20. Unusual sinonasal foreign body: presentation of three cases.

    PubMed

    Nazar, Rodolfo; Cabrera, Natalia; Martelo, Grettel; Machiavello, Cecilia; Naser, Alfredo

    2014-01-01

    Sinonasal foreign bodies are rare clinical entities. Their presence in the sinuses can originate complications, so their removal is always indicated. We present 3 cases of sinonasal foreign body, indicating their symptoms, imaging findings and surgical removal. Each patient was assessed with computerized tomography of the sinuses, rigid endoscopy, and then surgical removal. We confirmed the presence of the foreign bodies in all 3 cases and then performed a successful surgical removal by transnasal endoscopy. Sinonasal foreign bodies are infrequent entities that require surgical removal to prevent complications, with transnasal endoscopic surgery being the most commonly used surgical approach.

  1. The Utility of Sentinel Node Biopsy for Sinonasal Melanoma.

    PubMed

    Oldenburg, Michael S; Price, Daniel L

    2017-10-01

    Objective  Report two positive sentinel node biopsies for sinonasal melanoma. Design  Retrospective review. Setting  Academic tertiary care center. Participants  Patients who underwent sentinel node biopsy for sinonasal melanoma between November 1, 2014 and November 1, 2015. Main Outcome Measures  Clinical course. Results  Two patients were identified. Patient 1 (83M) presented with a sinonasal melanoma anterior to the left inferior turbinate and was clinically N0 neck. Lymphoscintigraphy revealed two sentinel nodes in the ipsilateral and three in the contralateral cervical basins. The left level I sentinel node was positive for melanoma and lymphadenectomy showed no additional metastases. Patient 2 (71F) presented after incomplete resection of a sinonasal melanoma of the left posterior maxillary sinus wall and was clinically N0 neck. Lymphoscintigraphy with single-photon emission computed tomography (SPECT/CT) localization revealed one sentinel node in the parapharyngeal space and another in the ipsilateral cervical basin. Metastatic melanoma was found in both nodes and completion lymphadenectomy was negative for additional disease. Both patients developed distant metastasis in less than 1 year after surgical resection but responded well to adjuvant immunomodulatory chemotherapeutic agents. Conclusion  Sentinel node biopsy for sinonasal melanoma can provide crucial clinical evidence of regional metastasis prior to overt clinical signs and symptoms. This intraoperative tool has the potential to improve detection of regional metastasis and improve long-term outcomes of this aggressive malignancy.

  2. Delayed diagnosis of sinonasal lymphoma due to bilateral manifestation.

    PubMed

    Kiessling, Si-Young; Soyka, Michael B; Huber, Gerhard F; Holzmann, David; Laske, Roman D

    2017-02-01

    The objective of this study is to analyze the presenting symptoms, the time to correct diagnosis and outcome of a European patient cohort with sinonasal lymphoma focusing on unilateral vs. bilateral sinonasal involvement. In a retrospective setting in a European tertiary referral center, eleven patients (9 males, 2 females) with sinonasal lymphoma diagnosed between 2002 and 2015 were identified and divided into a unilateral and bilateral group according to their CT finding. Clinical findings on first presentation, the presence of B symptoms, the radiologic findings, overall survival and disease-specific survival were assessed. 55 % of the patients suffered from bilateral manifestation, which was associated with a delayed diagnosis (10 vs. 1.5 months, p < 0.05). B symptoms (67 vs. 0 %) and death of disease (50 vs. 0 %) were observed only in the bilateral group. Nasal NK/T-cell lymphoma was the most frequent diagnosis, followed by diffuse large B-cell lymphoma. Bilateral mucosal manifestation with B symptoms was shown to be common within the rare entity of sinonasal lymphomas and patients with bilateral sinonasal manifestation are at risk for a delayed diagnosis with worse outcome.

  3. Evaluation of variations in sinonasal region with computed tomography

    PubMed Central

    Dasar, Ufuk; Gokce, Erkan

    2016-01-01

    AIM: To investigate the frequency of anatomical variations in sinonasal region and association of these variations with mucosal diseases. METHODS: The study included 400 cases (191 female and 209 male) who were considered to have preliminary diagnoses of sinonasal pathology and who had paranasal sinus computed tomography (CT) examination in axial plane. Reformatted CT images were studied in all planes. RESULTS: Age range of the patients was 20-83 (mean 40.26 ± 14.85). Most commonly detected anatomical variation was Agger nasi cell (74.8%). There was a significant association between clinoid process pneumatization and protrusion of internal carotid arteries and optic nerves into sphenoid sinus (P < 0.001). Besides, the relationships between pterygoid process pneumatization and protrusion of vidian nerve into sphenoid sinus, and between pneumatization of large sphenoid wing and protrusion of maxillary nerves into sphenoid sinus were also significant (P < 0.001). Uncinate bulla and giant ethmoid bulla were found to be significantly associated with sinonasal mucosal diseases (P = 0.004 and P = 0.002, respectively). CONCLUSION: Sinonasal region has a great number of variations, and some of them have been determined to be associated with sinonasal mucosal disease. It is necessary to know that some of these variations are associated with protrusion of significant structures such as carotid artery or optic nerve into the sinus and care should be observed in surgeries on patients carrying these variations. PMID:26834948

  4. Occupational risks of sinonasal cancer in Denmark.

    PubMed Central

    Olsen, J H

    1988-01-01

    A new comprehensive data linkage system for the detailed investigation of occupational cancer has been established in the Danish Cancer Registry, providing employment histories back to 1964. All 382 cases of cancers of the sinonasal cavities diagnosed between 1970 and 1984 and kept on file in this data linkage system were analysed using standardised proportional incidence ratios (SPIR) to screen for industrial high risk areas for these malignancies in Denmark. Excess risks were confirmed among men and women employed in the manufacture of footwear and other leather products and of wooden furniture. No risk significantly above expectancy was observed among wood workers outside the furniture making industry. Excess risks were also seen among men in all areas of basic metal industries (SPIR = 184-562) and in a subset of workers in industries producing metal containers (SPIR = 329-600). Most unexpected were raised risks among employees of both sexes in making cocoa, chocolate, and sugar confectionery (SPIR = 535 for men and 860 for women); these, in combination with the observed risks among female employees in canning and preserving fruits and vegetables (SPIR = 778) and in farming (SPIR = 735) may point to a common aetiology. The obscuring effect of mass significance may, however, be another explanation. The new associations discovered in this large scale linkage study must therefore await further confirmation. PMID:3378013

  5. Occupational risks of sinonasal cancer in Denmark.

    PubMed

    Olsen, J H

    1988-05-01

    A new comprehensive data linkage system for the detailed investigation of occupational cancer has been established in the Danish Cancer Registry, providing employment histories back to 1964. All 382 cases of cancers of the sinonasal cavities diagnosed between 1970 and 1984 and kept on file in this data linkage system were analysed using standardised proportional incidence ratios (SPIR) to screen for industrial high risk areas for these malignancies in Denmark. Excess risks were confirmed among men and women employed in the manufacture of footwear and other leather products and of wooden furniture. No risk significantly above expectancy was observed among wood workers outside the furniture making industry. Excess risks were also seen among men in all areas of basic metal industries (SPIR = 184-562) and in a subset of workers in industries producing metal containers (SPIR = 329-600). Most unexpected were raised risks among employees of both sexes in making cocoa, chocolate, and sugar confectionery (SPIR = 535 for men and 860 for women); these, in combination with the observed risks among female employees in canning and preserving fruits and vegetables (SPIR = 778) and in farming (SPIR = 735) may point to a common aetiology. The obscuring effect of mass significance may, however, be another explanation. The new associations discovered in this large scale linkage study must therefore await further confirmation.

  6. Middle ear function in sinonasal polyposis.

    PubMed

    Bakhshaee, Mehdi; Ardakani, Hossein Payedar; Ghazizadeh, Amir Hossain; Movahed, Rahman; Jarahi, Lida; Rajati, Mohsen

    2016-10-01

    Nasal airway patency has long been considered a major factor in ear health. The aim of this study was to determine the effect of sinonasal polyposis on middle ear and eustachian tube (ET) functionality. Forty-four individuals with polyposis, 23 with non-polyposis nasal obstruction, and 23 healthy controls were enrolled. Demographic, clinical and imaging data of all participants were collected and ET function tests and audiologic tests were performed. Hearing loss (p = 0.02), flat tympanogram (p = 0.02), disturbed Toynbee and Valsalva tests (p = 0.01), and the prevalence of allergy (p = 0.04) and purulent nasal discharge (p < 0.001) were significantly higher in the polyposis group than the other groups. Regression analysis revealed that infection and allergy have more important roles in ET function than the nasal obstruction. Polyposis could impede ET function; however, it is probably not because of its obstructive nature, but because of the associated increased risk of infection.

  7. Sinonasal glomangiopericytoma: case report with emphasis on the differential diagnosis.

    PubMed

    Dandekar, Monisha; McHugh, Jonathan B

    2010-10-01

    Glomangiopericytoma (sinonasal-type hemangiopericytoma) is an uncommon sinonasal neoplasm with a perivascular myoid phenotype. This tumor differs from conventional soft tissue hemangiopericytoma in location, biologic behavior, and histologic features. The proposed cell of origin is a modified perivascular glomuslike myoid cell. Glomangiopericytoma is an indolent tumor that tends to arise in the sinonasal tract of older adults and has a low malignant potential with excellent prognosis after surgical resection. Histologically, this lesion is composed of a diffuse, subepithelial proliferation of bland, uniform, closely packed spindled cells growing in a variety of patterns. A distinctive vascular network composed of variably sized vascular channels, the smaller of which demonstrate perivascular hyalinization, is often present. We report the case of a 48-year-old woman with epistaxis and nasal obstruction who was diagnosed with glomangiopericytoma and discuss the histologic differential diagnosis.

  8. Sinonasal glomangiopericytoma treated with preoperative embolisation and endoscopic sinus surgery

    PubMed Central

    Psoma, Elizabeth; Karkos, Petros D; Dova, Stamatia; Gavriilidis, Michail; Markou, Konstantinos; Kouskouras, Constantinos; Haritanti, Afroditi; Finitsis, Stefanos

    2016-01-01

    Sinonasal glomangiopericytoma is a benign rare tumour of pericytes that accounts for less than 0.5% of all sinonasal tumours. It is an indolent tumour with a macroscopic appearance of common inflammatory polyps. We report the case of a 55-year-old male who presented with right nasal obstruction. CT and MRI examinations demonstrated a soft-tissue mass that obstructed mainly the right nasal cavity. Biopsy revealed glomangiopericytoma. The tumour was treated with preoperative embolisation followed by complete endoscopic resection. Very few cases have been reported to be treated in this way. PMID:27994648

  9. Sinonasal Neoplasia – Clinicopathological Profile And Importance of Computed Tomography

    PubMed Central

    Sarawagi, Radha; Raghuwanshi, Sameer; Yadav, Pankaj Kumar

    2015-01-01

    Background Nasal cavity and Paranasal sinus malignancies are very rare, in which maxillary sinus is the commonest, followed by ethmoid, frontal and sphenoid sinus. Computed Tomography (CT) & Magnetic Resonance Imaging (MRI) play a key role in diagnosis, staging and management of paranasal sinuses and nasal pathologies. Multiplanar imaging in CT helps better imaging of critical anatomical areas. Aim of our study was to study the incidence, clinical features, CT features and its importance in the management of sinonasal neoplasms. Materials and Methods This prospective study was carried out in a tertiary care hospital of MP, India. Consecutive 40 histologically proven cases of sinonasal neoplasia who visited the Department of Otorhinolaryngology and Radiotherapy are included in our study. Demography and clinical features were recorded. Cases of nasal and paranasal sinus masses diagnosed on CT attending ENT and Radiotherapy OPD or admitted in the Radiotherapy ward forms the material of this study. This included patients of both sexes and all ages. Histopathological examination was asked to confirm the diagnosis made on CT. Results There were total 40 cases of sinonasal neoplasia among which 24 were benign. Almost all the benign cases were seen in the age group <40 y with mean age of 20 y and most of the malignant cases were seen in the age group above 40 y with mean age of 55 y. In our study we found male preponderance with male female ratio of 4:1 in both benign and malignant conditions. The commonest presenting symptoms of the patients with sinonasal masses in our study was nasal obstruction (75%) and nasal discharge (67.5%) followed by nasal mass (65%), epistaxis (62.5%) and headache (60%). Angiofibroma and papilloma were the commonest benign lesions. Commonest malignant lesion was squamous cell carcinoma. Of the malignant Sinonasal tumours studied in our series, maxillary sinus was involved in 13, ethmoid sinuses and nasal cavity in 10 cases each, and frontal

  10. [Contribution of endoscopic laser coagulation in the treatment of multicentric sinonasal inverted papilloma. A case report].

    PubMed

    Jawhar, S S; Gassab, E; Kermani, W; Gassab, A

    2007-01-01

    To describe a new method of treatment of multicentric sinonasal inverted papilloma by laser endoscopic coagulation. We report a case of multicentric sinonasal inverted papilloma involving the nasopharynx in a 62-year-old man. The treatment was a laser diod cauterisation. The evolution was favourable without complications or recurrence after a 16 months follow-up period. Laser endoscopic coagulation seems to be an effective treatment for multicentric sinonasal inverted papilloma especially for lesions with a difficult surgical access.

  11. Sinonasal adenoid cystic carcinoma presenting as an orbital mass.

    PubMed

    Kwon, Robert O; Lyon, David B; Floyd, Michael; Girod, Douglas A

    2010-01-01

    A 61-year-old man with a history of sinus polyposis and prior sinus surgery presented with left-sided retrobulbar pain and headache. He was found to have left-sided proptosis, and imaging studies showed a large left medial orbital soft-tissue mass. Incisional biopsy revealed adenoid cystic carcinoma. Further evaluation revealed extensive sinonasal adenoid cystic carcinoma. The patient underwent en bloc maxillectomy with orbital exenteration and partial rhinectomy, followed by radiation therapy. The medial orbit is an unusual location for adenoid cystic carcinoma, which the authors believe was a secondary manifestation due to perineural spread from the sinuses via the ethmoidal nerves. Adenoid cystic carcinoma should be included in the differential diagnosis of tumors of the medial orbit, especially if there is a history of sinonasal disease.

  12. Sinonasal adamantinoma-like Ewing sarcoma: A case report.

    PubMed

    Alexiev, Borislav A; Tumer, Yanki; Bishop, Justin A

    2016-12-02

    We describe the case of a sinonasal adamantinoma-like Ewing sarcoma in a 41-year-old male. Histologically, the tumor exhibited distinctive areas of nested growth pattern with prominent stromal fibrosis and metaplastic bone formation. The tumor cells were small and uniform with minimal amount of pale eosinophilic to clear cytoplasm and round or oval nuclei with finely dispersed chromatin and small nucleoli. Approximately 20% of the tumor parenchyma comprised of small clusters of basaloid cells within an osteofibrous background resembling adamantinoma. The tumor showed strong expression of keratins, p63, CD99 and Fli-1, and EWSR1 rearrangement. The diagnosis of sinonasal Ewing family tumors is particularly problematic owing to the large number of potential mimics. For any poorly differentiated or undifferentiated head and neck tumor, cellular monotony and CD99 immunoreactivity should prompt consideration for molecular studies that include analysis of both EWSR1 and FLI1, even in the presence of strong cytokeratin expression or focal keratinization.

  13. Molecular characterisation of sinonasal carcinomas and their clinical implications.

    PubMed

    López, Fernando; Llorente, José Luis; Costales, María; García-Inclán, Cristina; Pérez-Escuredo, Jhudit; Alvarez-Marcos, César; Hermsen, Mario; Suárez, Carlos

    2013-01-01

    Sinonasal carcinomas are rare tumours with an unfavourable prognosis whose management is difficult and complex, leading to high morbidity and mortality despite improvements in the field of surgery and radiotherapy. An elevated number of these tumours can be attributed to occupational exposure. In comparison with other head and neck malignancies, studies of molecular changes in these tumours are infrequent. This review was focused on findings about the epidemiology and molecular and phenotypic characterisation of sinonasal carcinomas, which can potentially be useful for diagnosis and treatment. The increasing knowledge about the molecular biology that underlies their carcinogenesis may help to identify precursor lesions, prognostic markers and markers that predict chemoradiotherapy response and, finally, to identify potential molecular targets that will expand treatment options.

  14. Sinonasal phosphaturic mesenchymal tumor: Case report and systematic review

    PubMed Central

    Cain, Rachel B.; McCullough, Ann E.; Hoxworth, Joseph M.; Lal, Devyani

    2014-01-01

    We report a case of sinonasal phosphaturic mesenchymal tumor (PMT) and conduct a systematic review of the literature to highlight a unique paraneoplastic syndrome associated with PMT. We used English language publications from Medline and Cochrane databases (1970–2013) as data sources. A systematic review of the literature was conducted. All reported cases of head and neck PMTs were included. The presence or absence of the associated paraneoplastic syndrome was noted. We found 33 cases of PMT in the head and neck reported in the literature, 17 of which occurred in the sinonasal area. Approximately 5% of all PMTs are located in the head and neck. Just greater than half are concentrated in the sinonasal area, and the remaining involve various bony and soft tissue structures of the head and neck. PMT is sometimes associated with a paraneoplastic syndrome of tumor-induced (oncogenic) osteomalacia (TIO) causing bone pain, muscle weakness, and pathologic fractures. We present the 18th reported case of sinonasal PMT. A smooth mucosa-covered midline intraseptal mass filling the posterior nasal cavity with destruction and erosion of the skull base was found in an adult male. The patient underwent successful endoscopic resection with wide negative margins and is without recurrence at 24-month follow-up. PMT is a benign, locally aggressive tumor with rare malignant transformation. Knowledge of the bony invasion and destruction caused by this tumor is essential in planning surgical resection with wide negative margins. Familiarity with the associated TIO is essential to investigate for and manage any associated bony morbidity. PMID:25565053

  15. Asbestos exposure and the risk of sinonasal cancer.

    PubMed

    Andersson, M; Selin, F; Järvholm, B

    2016-06-01

    While the increased risk of lung cancer and mesothelioma is well established, the relationship between exposure to asbestos dust and sinonasal cancer is less clear. To study the risk of sinonasal cancer in relation to asbestos dust exposure. A retrospective cohort study of construction workers, linked to the Swedish Cancer Registry. Participants were classified into four exposure groups; heavy, medium, low or very low exposure to asbestos, according to the incidence of pleural mesothelioma in their occupational group. Standardized incidence ratios (SIRs) and relative risks (RRs) were analysed, adjusted for age and smoking habits. The risks of adenocarcinoma and squamous cell carcinoma were investigated separately. Among the 280222 subjects, there was no increased risk of sinonasal cancer compared to the general population [SIR 0.85, 95% confidence interval (CI) 0.68-1.03], or any dose-response relationship with exposure to asbestos. The highest RR was found in the low exposure group (RR 1.25, 95% CI 0.69-2.28) and the lowest RR was found in the group with the highest exposure to asbestos (RR 0.71, 95% CI 0.33-1.53). No significantly increased risk or dose-response association could be found for adenocarcinoma or squamous cell carcinoma when analysed separately. This study did not find an increased risk of developing sinonasal cancer after asbestos exposure. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Aquaporin expression profiles in normal sinonasal mucosa and chronic rhinosinusitis.

    PubMed

    Frauenfelder, Claire; Woods, Charmaine; Hussey, Damian; Ooi, Eng; Klebe, Sonja; Carney, A Simon

    2014-11-01

    Thickened secretions, mucosal edema, and polyp formation are pathological features in chronic rhinosinusitis (CRS) that could theoretically be caused by aberrant water flow through sinonasal mucosa. Aquaporins (AQPs) are a family of proteins with roles in water transport, with tissue-specific expression profiles. This study aims to determine if AQP expression in sinonasal mucosa is different between normal controls and patients with CRS, either with (CRSwNP) or without (CRSsNP) nasal polyps. During endoscopic sinus surgery or transsphenoidal surgery, sinonasal tissue was collected and classified as CRSwNP (n = 13), CRSsNP (n = 10), or normal (n = 10). Messenger RNA (mRNA) expression of human AQP0 to AQP12b was determined using quantitative real-time polymerase chain reaction (qRT-PCR). Cellular localization of AQP1, AQP3, AQP4, AQP5, AQP7, and AQP11 was determined by immunohistochemistry. mRNA of AQP0 to AQP11 was identified in all samples. AQP12b mRNA was not detected. Significant differences in the mRNA expression levels of AQP4 and AQP11 were identified between normal and CRSwNP patients (p < 0.05). Differences in the cellular localization of AQPs were observed in both CRSsNP and CRSwNP patients vs normal controls. More intense localization to the cell cytoplasm was observed for AQP5 in glandular epithelium (CRSwNP; p < 0.05) and surface epithelium (CRSsNP; p < 0.05), and AQP4 in glandular epithelium (CRSsNP; p < 0.05). This study characterized AQP mRNA expression and protein localization in normal human sinonasal tissue. Significant differences in mRNA expression were found for AQP4 and AQP11 in CRSwNP and differences in protein localization patterns of AQP4 and AQP5 were identified in both types of CRS. © 2014 ARS-AAOA, LLC.

  17. Sinonasal extramedullary plasmacytoma: a systematic review of 175 patients.

    PubMed

    D'Aguillo, Christine; Soni, Resha S; Gordhan, Chirag; Liu, James K; Baredes, Soly; Eloy, Jean Anderson

    2014-02-01

    This study reviews the published literature related to extramedullary sinonasal plasmacytomas. Clinical presentation, demographics, treatment, and outcomes of this uncommon disease are reported. A systematic review of studies for sinonasal plasmacytomas from 1950 to 2012 was conducted. A PubMed database search, both for articles related to this condition along with bibliographies of those selected articles, was performed. Articles were examined for patient data that reported disease outcome. Sixty-seven journal articles were included in this analysis, comprising a total of 175 cases. Radiotherapy was the most common treatment modality, used in 89 cases, followed by a combination of surgery and radiotherapy, and surgery alone. A total of 71.8% of patients were alive after a median follow-up of 39 months, independent of treatment modality. A combination of radiotherapy and chemotherapy was rarely used but had the best treatment outcome, with 88.9% of patients (8/9 patients) alive. Of the 3 most common treatment modalities, a combination of radiotherapy and surgery had the most favorable outcomes. Sixteen patients (9.1%) converted to multiple myeloma, with the majority of these patients (75.0%) receiving radiotherapy alone as their treatment modality. This review contains the largest pool of sinonasal plasmacytoma patients to date and suggests aggressive radiotherapy is the most common treatment modality for this condition. Of the 3 most common treatment modalities, a combination of surgery and radiotherapy was shown to have the best survival outcomes. © 2013 ARS-AAOA, LLC.

  18. Histologic classification of sinonasal intestinal-type adenocarcinoma

    SciTech Connect

    Franquemont, D.W.; Fechner, R.E.; Mills, S.E. )

    1991-04-01

    Kleinsasser and Schroeder recently described a histologic classification system for woodworker-associated, intestinal-type adenocarcinomas of the sinonasal region. To determine if their approach is easily applied and prognostically meaningful for both woodworker-associated and sporadic intestinal-type adenocarcinomas in the sinonasal region, we analyzed 15 such cases. The 12 men and three women ranged in age from 37 to 75 years. Only four were woodworkers. All tumors arose in the nasal cavity or paranasal sinuses. The three authors independently classified the tumors with unanimous agreement in 11 (73%) of 15 cases. Disagreements were resolved by group review and consensus. Ten tumors were papillary tubular cylinder cell type; these were subdivided into grades I (four cases) and II (six cases) on the basis of cytologic atypia. Three tumors were alveolar goblet cell type; one tumor was signet-ring type; and one had a mixed pattern. Median survivals were papillary tubular I, 9 years; papillary tubular II, 3 years; and alveolar goblet cell, 7 years. It is concluded that this classification system is easy to apply, reproducible, and appears to identify a group of sinonasal intestinal-type adenocarcinomas (papillary tubular I) with a prolonged survival.

  19. Airborne Particulate Matter Induces Nonallergic Eosinophilic Sinonasal Inflammation in Mice.

    PubMed

    Ramanathan, Murugappan; London, Nyall R; Tharakan, Anuj; Surya, Nitya; Sussan, Thomas E; Rao, Xiaoquan; Lin, Sandra Y; Toskala, Elina; Rajagopalan, Sanjay; Biswal, Shyam

    2017-07-01

    Exposure to airborne particulate matter (PM) has been linked to aggravation of respiratory symptoms, increased risk of cardiovascular disease, and all-cause mortality. Although the health effects of PM on the lower pulmonary airway have been extensively studied, little is known regarding the impact of chronic PM exposure on the upper sinonasal airway. We sought to test the impact of chronic airborne PM exposure on the upper respiratory system in vivo. Mice were subjected, by inhalation, to concentrated fine (2.5 μm) PM 6 h/d, 5 d/wk, for 16 weeks. Mean airborne fine PM concentration was 60.92 μm/m(3), a concentration of fine PM lower than that reported in some major global cities. Mice were then killed and analyzed for evidence of inflammation and barrier breakdown compared with control mice. Evidence of the destructive effects of chronic airborne PM on sinonasal health in vivo, including proinflammatory cytokine release, and macrophage and neutrophil inflammatory cell accumulation was observed. A significant increase in epithelial barrier dysfunction was observed, as assessed by serum albumin accumulation in nasal airway lavage fluid, as well as decreased expression of adhesion molecules, including claudin-1 and epithelial cadherin. A significant increase in eosinophilic inflammation, including increased IL-13, eotaxin-1, and eosinophil accumulation, was also observed. Collectively, although largely observational, these studies demonstrate the destructive effects of chronic airborne PM exposure on the sinonasal airway barrier disruption and nonallergic eosinophilic inflammation in mice.

  20. Melanotic PEComa of the Sinonasal Mucosa With NONO-TFE3 Fusion: An Elusive Mimic of Sinonasal Melanoma.

    PubMed

    McGregor, Stephanie M; Alikhan, Mir B; John, Rahel A; Kotler, Howard; Bridge, Julia A; Mujacic, Ibro; Kadri, Sabah; Segal, Jeremy; Krausz, Thomas

    2017-05-01

    Perivascular epithelioid cell neoplasms (PEComas) are a family of mesenchymal tumors with features of both smooth muscle and melanocytic differentiation, with or without true melanin pigment. The highly variable morphology of PEComas results in a broad differential diagnosis that is also dependent on anatomic site. A subset demonstrates rearrangements involving the TFE3 (Xp11) locus, which can be used in diagnostically difficult cases. Here we describe a case of a melanotic PEComa with NONO-TFE3 fusion occurring in the sinonasal mucosa, as demonstrated by both next-generation sequencing and molecular cytogenetic studies. This case is the first of its kind in the literature and only the second documented PEComa harboring a NONO-TFE3 rearrangement. In light of unequivocal molecular ancillary studies, this case illustrates that PEComa must enter the differential for pigmented lesions of the sinonasal mucosa, where malignant melanoma would be much more likely to occur.

  1. Epidemiological Survey of Sinonasal Malignancy in North-East Iran

    PubMed Central

    Poursadegh, Mehdi; Poursadegh, Farid; Esmaeili, Majid; Bakhshaee, Mehdi

    2015-01-01

    Introduction: Sinonasal malignancies are uncommon neoplasms with several histological subtypes. These malignancies have a poor prognosis and, because of the nonspecific nature of the symptoms, most patients are diagnosed late when the disease is already at an advanced stage. Therefore, most sinonasal malignancies tend to be treated with surgery and postoperative radiotherapy. Understanding the incidence and prevalence of clinical symptoms, pathology, diagnosis, and subsequent prognosis of the disease is important for early diagnosis. Materials and Methods: Medical records of patients with a confirmed diagnosis of sinonasal malignancy in a tertiary referral center from 1998 to 2009 were retrospectively investigated by chronological examination. Information relating to symptoms, pathology, and treatment of patients were collected from the checklists and used to generate tables and graphs, while descriptive statistical tests were used to compare data. Results: The records of 69 patients were examined, including 45 (65.2%) male and 24 (34.8%) female patients with a combined mean age of 54.07±16.04 years. Twenty-one patients (30.4%) were aged less than 45 years and 48 (69.6%) were more than 45 years of age. The most common symptom was facial swelling in 46 (66.6%) patients and the most common kind of tumor was squamous cell carcinoma in 28 (40.6%) patients. The primary location of the tumor in most patients was the maxillary sinus (54 patients; 78.3%). A majority of patients present in advanced stage (stage III or more) with intraorbital (39.1%) or intracranial (4.3%) involvement, or regional lymphatic (28.99%) or distance metastasis (7.2%). The most common treatment was surgery (17 patients; 24.6%). Conclusion: Due to their nonspecific symptoms, most sinonasal malignancies are diagnosed at an advanced stage of the disease. Therefore, all patients with nonspecific symptoms, especially older males, should be evaluated for sinonasal malignancies in order to

  2. Transepithelial Ion Transport is Suppressed in Hypoxic Sinonasal Epithelium

    PubMed Central

    Blount, Angela; Zhang, Shaoyan; Chestnut, Michael; Hixon, Brian; Skinner, Daniel; Sorscher, Eric J.; Woodworth, Bradford A.

    2011-01-01

    Objectives/Hypothesis Sinonasal respiratory epithelial mucociliary clearance (MCC) is dependent on the transepithelial transport of ions such as Cl−. The objectives of the present study were to investigate the role of oxygen restriction in 1) Cl− transport across primary sinonasal epithelial monolayers, 2) expression of the apical Cl− channels CFTR and TMEM16A, and 3) the pathogenesis of chronic rhinosinusitis (CRS). Study Design In vitro investigation. Methods Murine nasal septal epithelial (MNSE, wild type) and human sinonasal epithelial (HSNE) cultures were incubated under hypoxic conditions (1% O2, 5% CO2). Cultures were mounted in Ussing chambers for ion transport measurements. CFTR and TMEM16A expression were measured using quantitative RT-PCR. Results The change in short-circuit current (ΔISC (µA/cm2) attributable to CFTR (forskolin-stimulated) was significantly decreased due to a 12 hour hypoxia exposure in both MNSE (13.55+/− 0.46 vs. 19.23+/−0.18) and HSNE (19.55+/−0.56 vs. 25.49+/−1.48 (control); p<0.05. TMEM16A (UTP-stimulated transport) was inhibited by 48 hours of hypoxic exposure in MNSE (15.92+/−2.87 vs. 51.44+/−3.71(control) p<0.05] and by 12 hours of hypoxic exposure in HSNE (16.75+/−0.68 vs. 24.15+/−1.35 (control). Quantitative RT-PCR (reported as relative mRNA levels+/−S.D.) demonstrated significant reductions in both CFTR and TMEM16A mRNA expression in MNSE and HSNE due to airway epithelial hypoxia. Conclusions Sinonasal epithelial CFTR and TMEM16A-mediated Cl− transport and mRNA expression were robustly decreased in an oxygen restricted environment. The findings in the present study indicate persistent hypoxia may lead to acquired defects in sinonasal Cl− transport in a fashion likely to confer mucociliary dysfunction in CRS. Level of Evidence 1b PMID:22024847

  3. Neoadjuvant Chemotherapy in Locally Advanced and Borderline Resectable Nonsquamous Sinonasal Tumors (Esthesioneuroblastoma and Sinonasal Tumor with Neuroendocrine Differentiation)

    PubMed Central

    Patil, Vijay M.; Joshi, Amit; Noronha, Vanita; Sharma, Vibhor; Zanwar, Saurabh; Dhumal, Sachin; Kane, Shubhada; Pai, Prathamesh; D'Cruz, Anil; Chaturvedi, Pankaj; Bhattacharjee, Atanu; Prabhash, Kumar

    2016-01-01

    Introduction. Sinonasal tumors are chemotherapy responsive which frequently present in advanced stages making NACT a promising option for improving resection and local control in borderline resectable and locally advanced tumours. Here we reviewed the results of 25 such cases treated with NACT. Materials and Methods. Sinonasal tumor patients treated with NACT were selected for this analysis. These patients received NACT with platinum and etoposide for 2 cycles. Patients who responded and were amenable for gross total resection underwent surgical resection and adjuvant CTRT. Those who responded but were not amenable for resection received radical CTRT. Patients who progressed on NACT received either radical CTRT or palliative radiotherapy. Results. The median age of the cohort was 42 years (IQR 37–47 years). Grades 3-4 toxicity with NACT were seen in 19 patients (76%). The response rate to NACT was 80%. Post-NACT surgery was done in 12 (48%) patients and radical chemoradiation in 9 (36%) patients. The 2-year progression free survival and overall survival were 75% and 78.5%, respectively. Conclusion. NACT in sinonasal tumours has a response rate of 80%. The protocol of NACT followed by local treatment is associated with improvement in outcomes as compared to our historical cohort. PMID:26955484

  4. The association between airline flight and sinonasal symptoms.

    PubMed

    Shargorodsky, Josef; Zheng, Laura; Stillman, Frances; Soong, Andrea; Navas-Acien, Ana; Reh, Douglas

    2016-04-01

    Airplane cabin supply air has been shown to contain multiple possible respiratory irritants. In addition, changes in barometric pressure in flight may contribute to specific respiratory conditions. Therefore, there may be an association between commercial airline flight and sinus disease. Participants of the Secondhand-Smoke, Air Quality and Respiratory Health Among Flight Attendants Study were administered an online questionnaire pertaining to their flight experience and respiratory health. Working years, working days per month, and number of trips per month were quantified, as well as smoking exposure and self-reported physician diagnoses of sinusitis, asthma, and rhinitis. The sinonasal outcomes were quantified using a Respiratory Questionnaire Survey (RQS) score. Multivariable analyses were performed to evaluate the associations between flight time and sinus disease. A total of 579 participants met the inclusion criteria for this study, with cohort prevalence of sinusitis, asthma, and rhinitis of 25.3%, 14.4%, and 20.5%, respectively. Tertiles 2 and 3 of working days per month were associated with higher RQS scores compared to tertile 1 (p for trend <0.01). Individual symptoms significantly associated with increasing number of working days per month included "need to blow nose," "sneezing," and "thick nasal discharge," and the number of international trips per month was significantly associated with "coughing" and "facial pain and pressure," among other symptoms. This is the largest study to analyze the relations between airline flight time and sinonasal disease. The results suggest a possible association between sinusitis diagnosis, symptom scores, and specific sinonasal symptoms, and airline flight time. © 2016 ARS-AAOA, LLC.

  5. Modeling alterations in sinonasal physiology after skull base surgery.

    PubMed

    Frank-Ito, Dennis O; Sajisevi, Mirabelle; Solares, C Arturo; Jang, David W

    2015-01-01

    Endonasal endoscopic skull base surgery (EESBS) often requires significant alterations in intranasal anatomy. For example, posterior septectomy (PS) with middle turbinate resection (MTR) is frequently performed to provide access to large sellar and clival tumors. However, little is known about the alterations that occur in sinonasal physiology. This study was designed to assess changes in sinonasal physiology after virtually performed endoscopic skull base surgery. Three-dimensional models of the sinonasal passage were created from computed tomography scans in three subjects with varying anatomy: no SD (SD), right anterior SD, and left anterior SD, respectively. Four additional surgery types were performed virtually on each model: endoscopic transsphenoidal approach (ETSA) with small (1 cm) PS (smPS), ETSA with complete (2 cm) PS, ETSA with smPS and right MTR, and ETSA with complete PS and right MTR. Computational fluid dynamics (CFD) simulations were performed on the 3 presurgery and 12 virtual surgery models to assess changes from surgery types. Increased nasal airflow corresponded to amount of tissue removed. Effects of MTR on unilateral airflow allocation were unchanged in subject with no SD, worsened in leftward SD, and reversed in rightward SD. Severity of airflow and mucosal wall interactions trended with amount of tissue removed. MTR hindered flow interactions with the olfactory mucosa in subjects with SD. CFD simulations on virtual surgery models are able to reasonably detect changes in airflow patterns in the computer-generated nasal models. In addition, each patient's unique anatomy influences the magnitude and direction of these changes after virtual EESBS. Once future studies can reliably correlate CFD parameters with patient symptoms, CFD will be a useful clinical tool in surgical planning and maximizing patient outcomes.

  6. Sinonasal teratocarcinosarcoma: An underdiagnosed entity posing diagnostic challenges.

    PubMed

    Sable, Mukund; Kakkar, Aanchal; Garg, Kanwaljeet; Suri, Vaishali

    2015-01-19

    Sinonasal teratocarcinosarcoma (SNTCS) is a rare malignancy of the nasal cavity and paranasal sinuses Histologically, this tumor comprises of mature and immature components of epithelial, mesenchymal and neuroectodermal origin, which may be present in varying proportions. This morphological heterogeneity often leads to misdiagnosis, particularly in biopsies. These patients have dismal prognosis, with frequent recurrences and short mean survival periods. Due to its rarity, clinical characteristics and optimal therapy are not well-characterized. We report a case of SNTCS with intracranial extension, which was treated with surgical resection, followed by radiotherapy. Knowledge of this entity is necessary for accurate diagnosis and proper management.

  7. SMARCB1(INI1)-deficient Sinonasal Basaloid Carcinoma

    PubMed Central

    Koch, Michael; Lell, Michael; Semrau, Sabine; Dudek, Wojciech; Wachter, David L.; Knöll, Antje; Iro, Heinrich; Haller, Florian; Hartmann, Arndt

    2014-01-01

    Poorly differentiated sinonasal carcinomas are a heterogenous group of aggressive neoplasms that encompasses squamous cell carcinoma including basaloid variant, lymphoepithelial carcinoma, sinonasal undifferentiated carcinoma, and neuroendocrine-type small cell carcinoma. We herein describe 3 cases of a hitherto unreported variant combining features of basaloid carcinoma with variable intermingled rhabdoid cells. Patients were 2 women (aged 28 and 35) and a man (52 y) who presented with sinonasal masses. All had advanced local disease with bone involvement (pT4). None had a history of irradiation or a family history of rhabdoid tumors. Treatment was surgery and adjuvant chemoradiation. One patient developed liver, lung, pleural, and pericardial metastases (63 mo) and is currently (70 mo) alive under palliative treatment. Another developed recurrent cervical lymph node metastases and died of disease 8.5 years later. The youngest patient was disease-free at last follow-up 7 years later. Histologic features were very similar in all 3 cases and showed intimate admixture of compact basaloid cell nests with peripheral palisading, perivascular pseudorosettes, and a few scattered rhabdoid cells. Rhabdoid cells were more extensive in the metastasis in 1 case but formed a minor inconspicuous component in the primary tumors in all cases. Striking features common to all cases were (1) basaloid “blue” appearance at low power, (2) papilloma-like exophytic component, (3) extensive pagetoid surface growth with prominent denuding features, and (4) replacement of underlying mucous glands mimicking an inverted papilloma. Clear-cut origin from benign papilloma and overt squamous differentiation were lacking. Diffuse (2) or partial (1) p16 expression was noted, but all cases lacked human papillomavirus DNA by molecular tests. In situ hybridization was negative for Epstein-Barr virus. Immunohistochemistry showed diffuse expression of pancytokeratin. CK5 and vimentin showed

  8. Relationship between (18)FDG-PET and different types of sinonasal malignancies.

    PubMed

    Felix-Ravelo, Marylisa; Bey, Ayoub; Arous, Fabien; Paris-Grandpierre, Solène; Jankowski, Roger; Nguyen, Duc Trung

    2017-02-01

    The sensitivity and specificity of a (18)FDG-PET scan may be different according to the histology. The SUVmax and SUV ratio may reflect the tumor's aggressive behavior. To describe the characteristics of PET/CT scans, including the maximum standard uptake values (SUVmax), at initial diagnosis according to six main types of sinonasal malignancies: sinonasal adenocarcinoma (SNAC), sinonasal undifferentiated carcinoma (SNUC), adenoid cystic carcinoma (ACC), sinonasal malignant melanoma (SMM), olfactory neuroblastoma (ONB), and sinonasal neuroendocrine carcinoma (SNEC). A chart review of 50 patients who were diagnosed and treated for six sinonasal malignancy types over a period of 6 years was conducted. Any (18)F-FDG PET/CT scans for each patient were searched using the hospital's intranet. The SUVmax of the primary sinonasal site was recorded. The liver SUVs were utilized as reference SUVs. The SUV ratio was defined as the ratio of the SUVmax of the primary tumor and the SUVliver. The most common malignancy was SNAC (32%), followed by SNUC (24%), ONB (14%), ACC (10%), SMM (10%), and SNEC (10%). The SUVmax and SUV ratio values were significantly different between tumor types (p = 0.002 and 0.012, respectively). SNUC had the highest mean SUVmax (14.2), followed by SNAC (9.9). A similar mean SUVmax was observed for SMM, ONB, and ACC (∼ 7.0). SNEC up-takes the least (18)FDG among these six tumor types (mean SUVmax = 4.7).

  9. Poorly differentiated sinonasal tract malignancies: A review focusing on recently described entities.

    PubMed

    Agaimy, Abbas

    2016-01-01

    Sinonasal tract malignancies are uncommon, representing no more than 5% of all head and neck neoplasms. However, in contrast to other head and neck sites, a significant proportion of sinonasal neoplasms tend to display a poorly/ undifferentiated significantly overlapping morphology and a highly aggressive clinical course, despite being of diverse histogenetic and molecular pathogenesis. The wide spectrum of poorly differentiated sinonasal epithelial neoplasms with small "basaloid" blue cell morphology includes basaloid squamous cell carcinoma (both HPV+ and HPV-unrelated), nasopharyngeal-type lymphoepithelial carcinoma (EBV+), small/large cell neuroendocrine carcinoma, esthesioneuroblastoma, poorly differentiated carcinoma of salivary type (myoepithelial carcinoma and solid adenoid cystic carcinoma), NUT midline carcinoma, the recently described SMARCB1-deficient sinonasal carcinoma, sinonasal teratocarcinosarcoma and, as a diagnosis of exclusion, sinonasal undifferentiated carcinoma (SNUC). On the other hand, a variety of sarcomas, melanoma and haematolymphoid malignancies have a predilection for the sinonasal cavities, and they occasionally display aberrant cytokeratin expression and show small round cell morphology thus closely mimicking poorly differentiated carcinomas. This review summarizes the clinicopathological features of the most recently described entities and discuss their differential diagnosis with emphasis on those aspects that represent pitfalls.

  10. Nitric oxide production is stimulated by bitter taste receptors ubiquitously expressed in the sinonasal cavity

    PubMed Central

    Yan, Carol H.; Hahn, Samuel; McMahon, Derek; Bonislawski, David; Kennedy, David W.; Adappa, Nithin D.; Palmer, James N.; Jiang, Peihua; Lee, Robert J.

    2017-01-01

    Background: Bitter taste receptors (T2R) have recently been demonstrated to contribute to sinonasal innate immunity. One T2R, T2R38, regulates mucosal defense against gram-negative organisms through nitric oxide (NO) production, which enhances mucociliary clearance and directly kills bacteria. To determine whether additional T2Rs contribute to this innate defense, we evaluated two other sinonasal T2Rs (T2R4 and T2R16) for regulation of NO production and expression within the human sinonasal cavity. Methods: Primary human sinonasal cultures were stimulated with ligands specific to T2R4 and T2R16, colchicine and D-salicin, respectively. Cellular NO production was measured by intracellular 4-amino-5-methylamino-2′,7′-difluorofluorescein diacetate fluorescence. For T2R expression mapping, sinonasal tissue was obtained from patients who underwent sinus surgery of the middle turbinate, maxillary sinus, ethmoid sinus, or sphenoid sinus. The expression of T2R4, T2R16, and T2R38 was evaluated by using immunofluorescence with validated antibodies. Results: Similar to T2R38, T2R4 and T2R16 trigger NO production in a dose-dependent manner by using the canonical taste signaling pathway in response to stimulation with their respective ligands. All three receptors were expressed in the cilia of human epithelial cells of all regions in the sinonasal cavity. Conclusion: These three T2Rs signaled through the same NO-mediated antimicrobial pathway and were ubiquitously expressed in the sinonasal epithelium. Additional T2Rs besides T2R38 may play a role in sinonasal immune defense. Mapping of T2R expression demonstrated the potential widespread role of T2Rs in sinonasal defense, whereas the genetics of these T2Rs may contribute to our understanding of specific endotypes of chronic rhinosinusitis and develop into novel therapeutic targets. PMID:28452704

  11. Nitric oxide production is stimulated by bitter taste receptors ubiquitously expressed in the sinonasal cavity.

    PubMed

    Yan, Carol H; Hahn, Samuel; McMahon, Derek; Bonislawski, David; Kennedy, David W; Adappa, Nithin D; Palmer, James N; Jiang, Peihua; Lee, Robert J; Cohen, Noam A

    2017-03-01

    Bitter taste receptors (T2R) have recently been demonstrated to contribute to sinonasal innate immunity. One T2R, T2R38, regulates mucosal defense against gram-negative organisms through nitric oxide (NO) production, which enhances mucociliary clearance and directly kills bacteria. To determine whether additional T2Rs contribute to this innate defense, we evaluated two other sinonasal T2Rs (T2R4 and T2R16) for regulation of NO production and expression within the human sinonasal cavity. Primary human sinonasal cultures were stimulated with ligands specific to T2R4 and T2R16, colchicine and D-salicin, respectively. Cellular NO production was measured by intracellular 4-amino-5-methylamino-2',7'-difluorofluorescein diacetate fluorescence. For T2R expression mapping, sinonasal tissue was obtained from patients who underwent sinus surgery of the middle turbinate, maxillary sinus, ethmoid sinus, or sphenoid sinus. The expression of T2R4, T2R16, and T2R38 was evaluated by using immunofluorescence with validated antibodies. Similar to T2R38, T2R4 and T2R16 trigger NO production in a dose-dependent manner by using the canonical taste signaling pathway in response to stimulation with their respective ligands. All three receptors were expressed in the cilia of human epithelial cells of all regions in the sinonasal cavity. These three T2Rs signaled through the same NO-mediated antimicrobial pathway and were ubiquitously expressed in the sinonasal epithelium. Additional T2Rs besides T2R38 may play a role in sinonasal immune defense. Mapping of T2R expression demonstrated the potential widespread role of T2Rs in sinonasal defense, whereas the genetics of these T2Rs may contribute to our understanding of specific endotypes of chronic rhinosinusitis and develop into novel therapeutic targets.

  12. Spanish consensus for the management of sinonasal tumors.

    PubMed

    López, Fernando; Grau, Juan José; Medina, José Antonio; Alobid, Isam

    Sinonasal tumors are rare neoplasms with distinctive clinical, aetiological and pathological features. The diagnosis and treatment of these tumours is challenging because of their low incidence, histological diversity and production of non-specific symptoms in the early stages. They have a variable prognosis depending on their histology, origin and staging. Their location, close to neurocritical structures, which are of special relevance to surgery and postoperative treatment, makes their treatment difficult and complex, leading to high morbidity and mortality. Surgery followed by radiotherapy is the mainstay of treatment. To provide the best possible care, patients with sinonasal cancer should be treated in clinical referral centres specializing in skull-base pathologies. Such centres should include a multidisciplinary team led by otolaryngologist surgeons. This article outlines a consensus protocol for the management of these tumours devised by the Spanish Society of Otolaryngology in collaboration with the Spanish Society of Medical Oncology and the Spanish Society for Radiation Oncology. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  13. Cost-effectiveness assessment in outpatient sinonasal surgery.

    PubMed

    Mortuaire, G; Theis, D; Fackeure, R; Chevalier, D; Gengler, I

    2017-09-15

    To assess the cost-effectiveness of outpatient sinonasal surgery in terms of clinical efficacy and control of expenses. A retrospective study was conducted from January 2014 to January 2016. Patients scheduled for outpatient sinonasal surgery were systematically included. Clinical data were extracted from surgical and anesthesiology computer files. The cost accounting methods applied in our institution were used to evaluate logistic and technical costs. The standardized hospital fees rating system based on hospital stay and severity in diagnosis-related groups (Groupes homogènes de séjours: GHS) was used to estimate institutional revenue. Over 2years, 927 outpatient surgical procedures were performed. The crossover rate to conventional hospital admission was 2.9%. In a day-1 telephone interview, 85% of patients were very satisfied with the procedure. All outpatient cases showed significantly lower costs than estimated for conventional management with overnight admission, while hospital revenue did not differ between the two. This study confirmed the efficacy of outpatient surgery in this indication. Lower costs could allow savings for the health system by readjusting the rating for the procedure. More precise assessment of cost-effectiveness will require more fine-grained studies based on micro costing at hospital level and assessment of impact on conventional surgical activity and post-discharge community care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. CT and MR imaging findings of sinonasal angiomatous polyps.

    PubMed

    Zou, Jing; Man, Fengyuan; Deng, Kai; Zheng, Yuanyuan; Hao, Dapeng; Xu, Wenjian

    2014-03-01

    To characterize the CT and MR imaging findings of patients with sinonasal angiomatous polyps (SAPs) and evaluate their respective clinical value in the diagnosis of SAP. CT and MR imaging findings of 15 patients with pathologically proven SAP were examined. Assessed image features included location, size, margin, attenuation, and change of the bony walls of the sinonasal cavity on CT, and signal intensity and enhancement pattern on MR. On CT, the SAP was mostly isoattenuated with patches of slight hyperattenuation. Most lesions caused changes in the adjacent bone, including expansile remodeling (n=8), defect or destruction (n=7), and hyperostosis (n=6). All lesions examined by MR showed heterogeneous isointense signal intensity on T1-weighted images and mixed obvious hyperintense and hypointense signal intensity with linear hypointense septum internally (n=10), and hypointense peripheral rim on T2-weighted images (n=10). Postcontrast MR images demonstrated areas of heterogeneous and marked enhancement with an unenhanced hypointense rim and septa (n=7). CT and MR imaging have respective advantages in the diagnosis of SAP. Combined application of CT and MR examinations is necessary for patients with suspected SAP. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Aspergillus fumigatus biofilm on primary human sinonasal epithelial culture.

    PubMed

    Singhal, Deepti; Baker, Leonie; Wormald, Peter-John; Tan, Lorwai

    2011-01-01

    Bacterial biofilms have been implicated in chronic rhinosinusitis (CRS). However, direct evidence in support of fungal biofilms in sinus disease is lacking in the literature. This study was designed to develop and characterize an in vitro Aspergillus fumigatus biofilm model on primary human sinonasal epithelial cell culture. Sinonasal biopsy specimens harvested during endoscopic sinus surgery of six CRS patients and three pituitary tumor (control) patients were cultured in Dulbecco's modified Eagle media (DMEM; Invitrogen)/Hams F12 airway media to encourage epithelial cell proliferation. Epithelial cells separated by immunomagnetic beads were seeded in tissue culture-treated Y-shaped microslides. At confluence the primary cultures were inoculated with A. fumigatus spores. Fungus was allowed to germinate and form biofilms under two in vitro conditions: (1) static (no flow through of media) and (2) continuous flow coculture (continuous flow movement of media). At regular intervals cocultures were stained with FUN-1, concanavalin A-alexa fluor 488, and examined by confocal scanning laser microscopy. Comstat software was used to assess biomass and thickness. A. fumigatus formed three-dimensional biofilm structures with parallel-packed, cross-linked hyphae and channels/passages. Metabolically active hyphae showed orange-red fluorescing intravacuolar structures. Extracellular matrix (ECM) between/around the hyphae fluoresced intense green. A. fumigatus biofilms development occurred in five stages: (1) conidial attachment to epithelial cells, (2) hyphal proliferation, (3) ECM production, (4) hyphal parallel packing and cross-linking, and (5) channel/pores formation. Mature biofilms showed basal conidial, middle hyphal, and superficial ECM layers. Biofilms formed under flow conditions displayed more robust and faster growth kinetics when compared with that under static conditions, with a thick, stocky, wrinkly/undulating hyphal growth and extensive ECM production. The

  16. OTX1 and OTX2 as Possible Molecular Markers of Sinonasal Carcinomas and Olfactory Neuroblastomas

    PubMed Central

    Pirrone, Cristina; Chiaravalli, Anna M.; Marando, Alessandro; Conti, Andrea; Rainero, Alessia; Pistochini, Andrea; Curto, Francesco Lo; Pasquali, Francesco; Castelnuovo, Paolo; Capella, Carlo; Porta, Giovanni

    2017-01-01

    OTX Homeobox genes are involved in embryonic morphogenesis and in the development of olfactory epithelium in adult. Mutations occurring in the OTX genes are reported to be associated to tumorigenisis in human. No reports correlate the expression of OTX genes and neoplasms of the nasal cavity. Thus, through immunohistochemical and Real-time PCR analysis we investigated OTX1 and OTX2 expression in the more frequent types of nasal and sinonasal tumours. Variable expression of both genes were found in normal sinonasal mucosa and in tumours. Interestingly, no expression of both OTX genes were detected in sinonasal intestinal-type adenocarcinomas; only OTX1 was found in non-intestinal-type adenocarcinomas and OTX2 was selectively expressed in olfactory neuroblastomas. In conclusion, OTX1 and OTX2 genes might have a role in the pathogenesis of different types of sinonasal neoplasms. PMID:28348423

  17. Imaging in Rare and Atypical Sinonasal Masses: An Interesting Case Series.

    PubMed

    Sanyal, Shantiranjan; Prasad, Akhila; Baruah, Deb Kumar; Garga, Umesh Chandra

    2015-12-01

    Sinonasal tumours present a myriad of radiographic findings. While many of these tumours have been well described with regard to their typical sites of origin, age group and radiological appearance we have come across lesions in our daily practice which are exceedingly rare with regard to site of origin in sinonasal cavity. The radiological appearances of 4 such rare and unusual tumours arising in sinonasal region evaluated by cross sectional imaging (CT/MRI) have been illustrated in this article with a purpose to review the radio-pathological correlation of these tumours and to explain the utility of cross-sectional imaging CT and MRI in exploring diagnostic clues. Morphological features and radiological patterns of each tumour have been graded into mild, moderate and severe based on the extent of tumoural involvement. This review is intended to acquaint radiologists with the appearance of atypical sinonasal masses and their radiological appearance on cross sectional imaging to make an early diagnosis.

  18. Sinonasal Fungal Infections and Complications: A Pictorial Review

    PubMed Central

    Gavito-Higuera, Jose; Mullins, Carola Birgit; Ramos-Duran, Luis; Sandoval, Hugo; Akle, Nassim; Figueroa, Ramon

    2016-01-01

    Fungal infections of the nose and paranasal sinuses can be categorized into invasive and non-invasive forms. The clinical presentation and course of the disease is primarily determined by the immune status of the host and can range from harmless or subtle presentations to life threatening complications. Invasive fungal infections are categorized into acute, chronic or chronic granulomatous entities. Immunocompromised patients with poorly controlled diabetes mellitus, HIV and patients receiving chemotherapy or chronic oral corticosteroids are mostly affected. Mycetoma and Allergic Fungal Rhinosinusitis are considered non-invasive forms. Computer tomography is the gold-standard in sinonasal imaging and is complimented by Magnetic resonance imaging (MRI) as it is superior in the evaluation of intraorbital and intracranial extensions. The knowledge and identification of the characteristic imaging patterns in invasive – and non- invasive fungal rhinosinusitis is crucial and the radiologist plays an important role in refining the diagnosis to prevent a possible fatal outcome. PMID:27403401

  19. Advances in recurrence and malignant transformation of sinonasal inverted papillomas

    PubMed Central

    Sun, Qingjia; An, Lifeng; Zheng, Jun; Zhu, Dongdong

    2017-01-01

    Sinonasal inverted papilloma (SIP) is a benign tumor of the nasal cavity and sinus. SIP is characterized by aggressive malignant transformation and a high rate of recurrence. Inadequate removal of the tumor during surgery is one of the most significant contributors to SIP recurrence. A growing body of evidence suggests that molecular alteration in SIP, including human papilloma virus infections, single nucleotide polymorphisms of key genes, deregulation of signaling pathways and immunological changes, may lead to SIP occurrence and malignant transformation. However, the extent to which these molecular mechanisms contribute to SIP pathology and transformation remains unclear due to limited research. Further studies are warranted to elucidate the primary dependent factors that contribute to SIP etiology. The present article reviewed risk factors of progression and recurrence of SIP, including outdoor and industrial occupational exposure, smoking, septal deviation, SIP location, recurrent cases, stage of SIP-associated squamous cell carcinoma and choice of surgical method. PMID:28599459

  20. The sinonasal bacterial microbiome in health and disease

    PubMed Central

    Ramakrishnan, Vijay R.; Hauser, Leah J.; Frank, Daniel N.

    2016-01-01

    Purpose of review The development of culture-independent bacterial DNA sequencing techniques and integration into research practice has led to a burgeoning interest in the microbiome and its relevance to human health and disease. Introduction into the study of chronic rhinosinusitis in the past few years has shaped current thinking on the role of bacteria in the disease process. Recent findings Rich and diverse populations of bacteria inhabit the sinonasal cavity at all times. Decreased bacterial richness and diversity may be associated with disease state and outcomes. Summary Although there is much to be explored, the sinus microbiome appears to have potentially promising roles in many aspects of sinus health and disease. PMID:26575518

  1. The role of systemic therapy in the management of sinonasal cancer: A critical review.

    PubMed

    Bossi, Paolo; Saba, Nabil F; Vermorken, Jan B; Strojan, Primoz; Pala, Laura; de Bree, Remco; Rodrigo, Juan Pablo; Lopez, Fernando; Hanna, Ehab Y; Haigentz, Missak; Takes, Robert P; Slootweg, Piet J; Silver, Carl E; Rinaldo, Alessandra; Ferlito, Alfio

    2015-12-01

    Due to the rarity and the variety of histological types of sinonasal cancers, there is a paucity of data regarding strategy for their optimal treatment. Generally, outcomes of advanced and higher grade tumors remain unsatisfactory, despite the employment of sophisticated surgical approaches, technical advances in radiation techniques and the use of heavy ion particles. In this context, we critically evaluated the role of systemic therapy as part of a multidisciplinary approach to locally advanced disease. Induction chemotherapy has shown encouraging activity and could have a role in the multimodal treatment of patients with advanced sinonasal tumors. For epithelial tumors, the most frequently employed chemotherapy is cisplatin, in combination with either 5-fluorouracil, taxane, ifosfamide, or vincristine. Only limited experiences with concurrent chemoradiation exist with sinonasal cancer. The role of systemic treatment for each histological type (intestinal-type adenocarcinoma, sinonasal undifferentiated carcinoma, sinonasal neuroendocrine carcinoma, olfactory neuroblastoma, sinonasal primary mucosal melanoma, sarcoma) is discussed. The treatment of SNC requires a multimodal approach. Employment of systemic therapy for locally advanced disease could result in better outcomes, and optimize the therapeutic armamentarium. Further studies are needed to precisely define the role of systemic therapy and identify the optimal sequencing for its administration in relation to local therapies. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Management of the orbit during endoscopic sinonasal tumor surgery.

    PubMed

    Christianson, Brandon; Perez, Carlos; Harrow, Brian; Batra, Pete S

    2015-10-01

    The primary aims of the study were to report preoperative imaging characteristics and intraoperative management of the orbit during endoscopic resection of benign and malignant sinonasal tumors. This study was a case series at an academic tertiary care center. Retrospective chart review and prospective imaging assessment was performed on 159 cases treated between July 2009 and December 2012. A total of 41 patients met predetermined inclusion criteria. Squamous cell carcinoma (17.1%) and inverted papilloma (31.7%) were the most common malignant and benign histology, respectively. Preoperative computed tomography (CT) scanning most commonly demonstrated erosion of the lamina papyracea (80.5%), whereas magnetic resonance imaging (MRI) most commonly illustrated loss of fat plane between tumor and extraocular muscle (53.1%). Endoscopic procedures to address the orbital interface included lamina papyracea resection (85.4%), dacryocystorhinostomy (26.8%), periorbita resection (26.8%), optic nerve decompression (7.3%), and orbital exenteration (2.4%). Oculoplastic surgery involvement was required in 31.7% of cases. Orbital complications included epiphora in 3 (7.3%) and diplopia in 2 (5.1%) patients. Postoperatively, no recurrences were noted in the benign group, whereas 6 (28.6%) recurrences were noted in 21 patients in the malignant group treated with intent to cure. Two patients died of disease due to distant metastases from mucosal melanoma and squamous cell carcinoma. This represents the largest series to date on endoscopic management of the orbit in benign and malignant sinonasal tumors. A majority of these cases can be managed by a purely endoscopic approach with low complication and recurrence rates, although a subset still require adjunct open approaches for successful tumor extirpation. © 2015 ARS-AAOA, LLC.

  3. A long-term study of 277 cases of equine sinonasal disease. Part 2: treatments and results of treatments.

    PubMed

    Tremaine, W H; Dixon, P M

    2001-05-01

    The treatments of 277 horses with equine sinonasal disease (1984-1996), described by Tremaine and Dixon (2001), are reported here. Long-term (median duration 24 months) outcomes of treatment of the more common disorders were good, with 92% of horses with sinonasal mycosis, 84% with primary sinusitis, 82% with sinus cysts, 78% with dental sinusitis and 75% with sinonasal trauma reported to have complete remission of clinical signs. However, only 33% of horses with progressive ethmoidal haematoma (PEH) and 12% with sinonasal neoplasia reported long term remission of clinical signs.

  4. A cytotoxic substance from Sangre de Grado.

    PubMed

    Itokawa, H; Ichihara, Y; Mochizuki, M; Enomori, T; Morita, H; Shirota, O; Inamatsu, M; Takeya, K

    1991-04-01

    Taspine has been isolated as a cytotoxic substance from Sangre de Grado, sap of Croton palanostigma (Euphorbiaceae), by bioassay guided fractionation. The cytotoxicity (IC50) of taspine was found to be 0.39 microgram/ml against KB cells and 0.17 microgram/ml against V-79 cells.

  5. Nodal metastasis and elective nodal level treatment in sinonasal small-cell and sinonasal undifferentiated carcinoma: a surveillance, epidemiology and end results analysis

    PubMed Central

    Mitra, Nandita; Alonso-Basanta, Michelle; Adappa, Nithin D; Palmer, James N; O'Malley, Bert W; Rassekh, Christopher H; Chalian, Ara; Cohen, Roger B; Lin, Alexander

    2016-01-01

    Objective: Risk of nodal involvement in patients with sinonasal small-cell carcinoma and sinonasal undifferentiated carcinoma (SNUC) has not been well defined because of their rarity. We describe a population-based assessment of specific nodal level involvement in this group of rare neuroectodermal tumours. Methods: The Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2011 identified patients with SNUC and sinonasal small-cell carcinoma. Overall neck involvement and individual nodal level involvement at presentation were assessed, and comparison was made with a contemporaneous cohort of patients with a borderline clinically significant risk of nodal involvement and recurrence. Results: Of 141 patients, 31 (22%) had gross nodal involvement at presentation (range 14–33% by site and histology). Non-nasal, non-ethmoid site with SNUC histology has the highest rates of initial nodal involvement, whereas higher stage and size do not predict for higher nodal involvement rates. Bilateral Levels 2–3 for all sinonasal small cell; Levels 2–3 for nasal or ethmoid SNUC; and bilateral Levels 1–3 in non-nasal/non-ethmoid SNUC have the highest rates of involvement compared with a clinical reference standard. Conclusion: We found high rates of initial nodal involvement in all SNUC and sinonasal small-cell carcinoma. We found higher initial involvement of Levels 2 and 3 and in certain cases to the Level 1 nodal levels, hypothesizing benefit for elective treatment to those levels. Advances in knowledge: With small single-institution series reporting conflicting nodal involvement rates, our data support high rates of nodal presentation at diagnosis, hypothesizing benefit for elective nodal treatment in this cohort. PMID:26559439

  6. Endoscopic surgical management of sinonasal inverted papilloma extending to frontal sinuses.

    PubMed

    Takahashi, Yukiko; Shoji, Fumi; Katori, Yukio; Hidaka, Hiroshi; Noguchi, Naoya; Abe, Yasuhiro; Kakuta, Risako Kakuta; Suzuki, Takahiro; Suzuki, Yusuke; Ohta, Nobuo; Kakehata, Seiji; Okamoto, Yoshitaka

    2016-11-10

    Sinonasal inverted papilloma has been traditionally managed with external surgical approaches. Advances in imaging guidance systems, surgical instrumentation, and intraoperative multi-visualization have led to a gradual shift from external approaches to endoscopic surgery. However, for anatomical and technical reasons, endoscopic surgery of sinonasal inverted papilloma extending to the frontal sinuses is still challenging. Here, we present our experience in endoscopic surgical management of sinonasal inverted papilloma extending to one or both frontal sinuses. We present 10 cases of sinonasal inverted papilloma extending to the frontal sinuses and successfully removed by endoscopic median drainage (Draf III procedure) under endoscopic guidance without any additional external approach. The whole cavity of the frontal sinuses was easily inspected at the end of the surgical procedure. No early or late complications were observed. No recurrence was identified after an average follow-up period of 39.5 months. Use of an endoscopic median drainage approach to manage sinonasal inverted papilloma extending to one or both frontal sinuses is feasible and seems effective.

  7. Esthesioneuroblastoma, Neuroendocrine Carcinoma, and Sinonasal Undifferentiated Carcinoma: Differentiation in Diagnosis and Treatment

    PubMed Central

    Su, Shirley Y.; Bell, Diana; Hanna, Ehab Y.

    2014-01-01

    Introduction Malignant sinonasal tumors comprise less than 1% of all neoplasms. A wide variety of tumors occurring primarily in this site can present with an undifferentiated or poorly differentiated morphology. Among them are esthesioneuroblastomas, sinonasal undifferentiated carcinomas, and neuroendocrine carcinomas. Objectives We will discuss diagnostic strategies, recent advances in immunohistochemistry and molecular diagnosis, and treatment strategies. Data Synthesis These lesions are diagnostically challenging, and up to 30% of sinonasal malignancies referred to the University of Texas MD Anderson Cancer Center are given a different diagnosis on review of pathology. Correct classification is vital, as these tumors are significantly different in biological behavior and response to treatment. The past decade has witnessed advances in diagnosis and therapeutic modalities leading to improvements in survival. However, the optimal treatment for esthesioneuroblastoma, sinonasal undifferentiated carcinoma, and neuroendocrine carcinoma remain debated. We discuss advances in immunohistochemistry and molecular diagnosis, diagnostic strategies, and treatment selection. Conclusions There are significant differences in prognosis and treatment for esthesioneuroblastoma, neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma. Recent advances have the potential to improve oncologic outcomes but further investigation in needed. PMID:25992139

  8. Positive airway pressure adherence and mask interface in the setting of sinonasal symptoms.

    PubMed

    Schell, Amy E; Soose, Ryan J

    2017-10-01

    Despite reports of lower positive pressure adherence rates with oronasal masks, patients with sinonasal problems are often prescribed this interface over a nasal interface. The aim of this study was to characterize the relationship between mask type and therapy adherence in the setting of sinonasal symptoms. Retrospective case series with chart review. We reviewed 328 patients who underwent positive pressure titration between January 2012 and May 2015. Follow-up adherence data were available for 218 patients (66.5%). Multivariate analysis examined whether patients with sinonasal symptoms have improved adherence with oronasal masks compared to nasal or nasal pillow interfaces. At a median follow-up of 95 days, positive pressure adherence in patients with sinonasal symptoms was highest with the nasal pillow interface. When compared with oronasal interfaces, the odds of adequate therapy adherence were >5 times greater with nasal pillow interfaces (odds ratio [OR] = 5.20, 95% confidence interval [CI] = 1.61-16.80, P = .006) and >3 times greater with nasal interfaces (OR = 3.67, 95% CI = 1.20-11.26, P = .02) in these symptomatic patients. The presence of nasal problems does not predict the need for an oronasal mask. Positive pressure adherence rates are higher with nasal and nasal pillow interfaces compared to oronasal masks, even in patients with sinonasal complaints. 4. Laryngoscope, 127:2418-2422, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  9. Low-Grade Epithelial Proliferations of the Sinonasal Tract.

    PubMed

    Bullock, Martin J

    2016-03-01

    Low-grade epithelial proliferations of the sinonasal tract include Schneiderian papillomas, respiratory epithelial adenomatoid hamartoma, seromucinous hamartoma and low-grade non-intestinal adenocarcinoma. There is considerable overlap in their clinical presentation, endoscopic appearance, and imaging features. Although well-described diagnostic criteria exist, a definitive diagnosis may be difficult to reach on a small biopsy. Schneiderian papillomas are divided into fungiform, inverted, and oncocytic types, each with characteristic clinical and morphological features. The latter two may progress to malignancy. The majority are still considered to be HPV-related. Two lesions are designated as hamartomas, but their pathogenesis remains uncertain, with inflammatory and neoplastic origins proposed. Respiratory epithelial adenomatoid hamartoma is increasingly being recognized for its association with chronic rhinosinusitis and olfactory cleft site of origin. Seromucinous hamartoma has gained attention in recent years and overlaps with both respiratory epithelial adenomatoid hamartoma and low-grade non-intestinal adenocarcinoma. Controversy surrounds their distinction, particularly from low-grade adenocarcinoma. The latter generally is cured by complete excision, with a 26 % risk of recurrence but rare metastases and deaths from disease.

  10. Sinonasal Globular Amyloidosis Simulating Malignancy: A Rare Presentation.

    PubMed

    Kumar, Binay; Pant, Bhawna; Kumar, Vikrant; Negi, Meghna

    2016-09-01

    Primary localized amyloidosis in the head and neck region is a rare entity. The most commonly involved organ is larynx. Primary amyloidosis localized to the sinonasal tract is extremely rare. We report one such case along with a brief review of the associated literature. The aim of reporting this case is to emphasize the fact that sometimes nasal amyloidosis can also present with signs and symptoms of nasal and nasopharyngeal malignancy. The definitive diagnosis in such cases depends upon histopathology and further confirmed by immunohistochemistry. A 55-year old male presented with recurrent episodes of nasal bleed, bilateral nasal obstruction, and bilateral hearing loss from last 7 years. On clinical examination a mass was found in the nasal cavity on both sides reaching up to the nasopharynx. Contrast enhanced CT scan revealed that the mass was extending up to the skull base and destroying bony landmarks of the nasal cavity and paranasal sinuses. Mass was proved to be amyloidosis after histopathological examination. It showed multiple blotches of globular submucosal deposit of amyloid, on staining with Congo red. Immunohistochemistry confirmed AL amyloidosis with expression of mixed kappa and lambda light chain immunoglobulin (κ > λ). No evidence of systemic amyloidosis was found after proper work up. It was managed by conservative surgery.

  11. Sinonasal oncocytic Schneiderian papilloma accompanied by intravascular lymphoma

    PubMed Central

    Koyama, Masamichi; Terauchi, Takashi; Koizumi, Mitsuru; Tanaka, Hiroko; Takeuchi, Kengo

    2016-01-01

    Abstract Introduction: F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is useful for the staging and assessment of treatment response in patients with lymphoma. Occasionally, benign lesions demonstrate avid FDG uptake and result in false positive findings. Case: We report the case of an 82-year-old man presenting with cutaneous lesions, which were histopathologically diagnosed as intravascular lymphoma. FDG-PET/CT for staging demonstrated an FDG-avid mass extending from the right maxillary sinus to the nasal cavity, moderate uptake in the adrenal glands, mild uptake in the knee and the foot, and faint uptake in the skin and subcutaneous tissue of the legs. He subsequently underwent biopsy of the paranasal mass, which was diagnosed as oncocytic Schneiderian papilloma without lymphoma invasion. Glucose transporter (GLUT) 1 staining was highly positive in the papilloma cells, resulting in high FDG avidity. After completion of chemotherapy, the abnormal FDG uptakes in the skin, soft tissue, and adrenal glands disappeared on PET/CT. However, avid FDG uptake persisted in the sinonasal Schneiderian papilloma for 15 months before regression. Conclusion: Benign tumors with oncocytic components may show avid FDG uptake. Therefore, correct diagnosis of oncocytic Schneiderian papilloma on FDG images is difficult when other accompanying malignant tumors, especially lymphoma, are present. If post-therapeutic PET/CT images show a discordant lesion, oncocytic tumors, albeit uncommon, should be considered in the differential diagnoses. PMID:27559965

  12. Sinonasal Melanoma: A Case Report and Literature Review

    PubMed Central

    Alves, I. S. S.; Berriel, L. G. S.; Pinto, M. B.; Oliveira, C. F. P.; Cazzotto, A. C.; Moura, W. V.

    2017-01-01

    Purpose. Sinonasal malignant mucosal melanoma is a rare, aggressive tumour. Nasal obstruction and epistaxis are the most commonly reported symptoms, although symptomatology may develop late and be nonspecific, which tends to delay diagnosis, resulting in a poorer prognosis. Case Report. This report describes a 64-year-old male patient with nasal obstruction and epistaxis. Computed tomography of the facial sinuses revealed a large lesion in the right nasal cavity, with infiltration into the left cavity, ethmoidal cells, and erosion of the cribriform plate. Initial incisional biopsy revealed an undifferentiated carcinoma of the right maxillary sinus, staged as T4aN0M0. Induction chemotherapy was initiated with cisplatin and etoposide. Response to treatment was complete. The patient was then submitted to radiotherapy with concomitant cisplatin. Immunochemical analysis revealed positivity for vimentin, S100, and HMB-45 (human melanoma black 45), a result compatible with a diagnosis of malignant melanoma. Discussion. Due to the rarity of the tumour and the patient's complete response to chemotherapy and since no blackened lesion had been found at the previous exam, treatment was continued as planned. The patient remains healthy, with no metastasis or recurrence. He is currently being monitored by the clinical oncology team. PMID:28255482

  13. Direct Tumor Embolization of Sinonasal Unclassified Spindle Cell Sarcoma with Onyx.

    PubMed

    Kansal, Ankit; Srinet, Prateek; Manes, Richard Peter

    2016-07-01

    To evaluate the use of a new tumor embolization agent, Onyx (Covidien, Dublin, Ireland), for the use of intraoperative embolization of a sinonasal unclassified spindle cell sarcoma. A 45-year-old female patient presented to the rhinology clinic with a nasal mass. A biopsy revealed a highly vascular mass consistent with a sinonasal unclassified spindle cell sarcoma. Secondary to its extensive vascularity, the patient underwent preoperative transarterial embolization (TAE) before definitive resection. Due to complex vascular anatomy including feeding vessels emanating from intracranial circulation, incomplete embolization was achieved. Subsequently, intraoperative embolization with Onyx at the time of resection was performed. Intraoperative Onyx use resulted in almost complete devascularization of the tumor with decreased risk of intracranial embolization. Intraoperative embolization with Onyx after an incomplete TAE can be a safe and effective method of achieving near-total embolization of sinonasal tumors.

  14. A randomised trial of flexible versus rigid nasendoscopy in outpatient sinonasal examination.

    PubMed

    Midwinter, K I; Ahmed, A; Willatt, D

    2001-08-01

    Nasendoscopy is used extensively in ENT clinics both as a diagnostic tool and for local postoperative care. Both flexible and rigid fibreoptic scopes are available for the purpose of sinonasal examination. A prospective study of a flexible versus rigid endoscope was carried out, randomly assigning one type of scope to each nostril of 56 patients presenting to clinic with sinonasal symptomatology. Patients awarded each type of scope a pain score on an analogue scale, according to the level of discomfort experienced, and the operator noted the number of structures seen. Significantly more structures were visualized with the rigid scope than the flexible scope (P = 0.05). The pain scores were similarly in favour of the rigid scope, showing a trend to less discomfort. The rigid nasendoscope is the scope of choice for sinonasal examinations in the outpatient clinic based on these data.

  15. Direct Tumor Embolization of Sinonasal Unclassified Spindle Cell Sarcoma with Onyx

    PubMed Central

    Kansal, Ankit; Srinet, Prateek; Manes, Richard Peter

    2016-01-01

    Objectives  To evaluate the use of a new tumor embolization agent, Onyx (Covidien, Dublin, Ireland), for the use of intraoperative embolization of a sinonasal unclassified spindle cell sarcoma. Methods  A 45-year-old female patient presented to the rhinology clinic with a nasal mass. A biopsy revealed a highly vascular mass consistent with a sinonasal unclassified spindle cell sarcoma. Secondary to its extensive vascularity, the patient underwent preoperative transarterial embolization (TAE) before definitive resection. Due to complex vascular anatomy including feeding vessels emanating from intracranial circulation, incomplete embolization was achieved. Subsequently, intraoperative embolization with Onyx at the time of resection was performed. Results  Intraoperative Onyx use resulted in almost complete devascularization of the tumor with decreased risk of intracranial embolization. Conclusions  Intraoperative embolization with Onyx after an incomplete TAE can be a safe and effective method of achieving near-total embolization of sinonasal tumors. PMID:27652195

  16. Improved planning of endoscopic sinonasal surgery from 3-dimensional images with Osirix® and stereolithography.

    PubMed

    Sánchez-Gómez, Serafín; Herrero-Salado, Tomás F; Maza-Solano, Juan M; Ropero-Romero, Francisco; González-García, Jaime; Ambrosiani-Fernández, Jesús

    2015-01-01

    The high variability of sinonasal anatomy requires the best knowledge of its three-dimensional (3D) conformation to perform surgery more safely and efficiently. The aim of the study was to validate the utility of Osirix® and stereolithography in improving endoscopic sinonasal surgery planning. Osirix® was used as a viewer and Digital Imaging and Communications in Medicine (DICOM) 3D imaging manager to improve planning for 114 sinonasal endoscopic operations with polyposis (86) and chronic rhinosinusitis (CRS) (28). Stereolithography rapid prototyping was used for 7 frontoethmoidal mucoceles. Using Osirix® and stereolithography, a greater number of anatomical structures were identified and this was done faster, with a statistically-significant clinical-radiological correlation (P<.01) compared with 2D CT plates. With a share of more than 75% of surgery performed by residents, surgical time was reduced by 38±12.3min in CRS and 42±27.9 in sinonasal polyposis. The fourth-year residents reached 100% surgical competence in critical surgical milestones with 16 surgeries (CI 12-19). The systematic use of Osirix® for visualisation and treatment of 3D sinonasal images from DICOM data files, along with the surgical team's ability to manipulate them as virtual reality, allows surgeons to perform endoscopic sinonasal surgery with greater confidence and in less time than using 2D images. Residents also achieve surgical competence faster, more safely and with fewer complications. This beneficial impact is increased when the surgical team has stereolithography rapid prototyping in more complex cases. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  17. Epidemiology and survival outcomes of sinonasal verrucous carcinoma in the United States.

    PubMed

    Alonso, Jose E; Han, Albert Y; Kuan, Edward C; Suh, Jeffrey D; John, Maie A St

    2017-09-02

    Verrucous carcinoma (VC) is a rare, variant of squamous cell carcinoma with benign cytohistopathologic features and a generally favorable prognosis. Epidemiologic and clinical outcomes data are lacking as a result of limited cases of sinonasal VC. To describe the incidence and determinants of survival of patients with verrucous carcinoma of the sinonasal tract between the years of 1973 to 2014 using the Surveillance, Epidemiology, and End Results (SEER) database. The SEER registry was utilized to calculate survival trends for patients with verrucous carcinoma of the sinonasal tract between 1973 and 2014. Patient data then was analyzed with respect to age, sex, race, and treatment modalities (surgery and radiation therapy). Overall survival (OS) and disease-specific survival (DSS) were calculated. A total of 86 cases of VC of the sinonasal tract were identified. The cohort was comprised of 69.8% males. The mean age at diagnosis was 67.4 years. The nasal cavity was the most common primary site (51.2%), followed by the maxillary sinus (40.7%) and nasopharynx (5.8%). The median OS was 97.6 months. 89.5% of cases underwent surgery and 20.9% received both surgery and radiation therapy. Overall survival at 2, 5, and 10 years was 73%, 59%, and 36%, respectively. On multivariate analysis, advanced age (P < 0.05) and primary site (P < 0.05) were associated with worse OS and DSS, respectively. Primary nasopharyngeal tumor site was associated with reduced DSS (P < 0.05). Surgery improved OS (P < 0.001) and DSS (P < 0.001). Verrucous carcinoma of the sinonasal tract is associated with a generally favorable prognosis. Age, primary site, and surgical therapy are independent predictors of OS and DSS, respectively. We present the first population-based analysis of sinonasal VC, thus clarifying the prognosis and reinforcing the management of this malignancy. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  18. Influence of Mesh Density on Airflow and Particle Deposition in Sinonasal Airway Modeling.

    PubMed

    Frank-Ito, Dennis O; Wofford, Matthew; Schroeter, Jeffry D; Kimbell, Julia S

    2015-06-11

    There are methodological ambiguities in the literature on mesh refinement analysis for computational fluid dynamics (CFD) modeling of physiologically realistic airflow dynamics and particle transport in the human sinonasal cavity. To investigate grid independence in discretization of the (sino)nasal geometry, researchers have considered CFD variables such as pressure drop, velocity profile, wall shear, airflow, and particle deposition fractions. Standardization in nasal geometry is also lacking: unilateral or bilateral nasal cavities with and without paranasal sinuses have been used. These methodological variants have led to inconsistencies in establishing grid-independent mesh densities. The aim of this study is to provide important insight in the role of mesh refinement analysis on airflow and particle deposition in sinonasal airway modeling. A three-dimensional reconstruction of the complete sinonasal cavity was created from computed tomography images of a subject who had functional endoscopic sinus surgery. To investigate airflow grid independence, nine different tetrahedral mesh densities were generated. For particle transport mesh refinement analysis, hybrid tetrahedral-prism elements with near-wall prisms ranging from 1 to 6 layers were implemented. Steady-state, laminar inspiratory airflow simulations under physiologic pressure-driven conditions and nebulized particle transport simulations were performed with particle sizes ranging from 1-20 μm. Mesh independence for sinonasal airflow was achieved with approximately 4 million unstructured tetrahedral elements. The hybrid mesh containing 4 million tetrahedral cells with three prism layers demonstrated asymptotic behavior for sinonasal particle deposition. Inclusion of boundary prism layers reduced deposition fractions relative to tetrahedral-only meshes. To ensure numerically accurate simulation results, mesh refinement analyses should be performed for both airflow and particle transport simulations

  19. Clinical effects of p53 overexpression in squamous cell carcinoma of the sinonasal tract

    PubMed Central

    Wang, Xiaowei; Lv, Wei; Qi, Fang; Gao, Zhiqiang; Yang, Hua; Wang, Weiqing; Gao, Yali

    2017-01-01

    Abstract Background: The level of p53 protein expression in sinonasal squamous cell carcinoma (SNSCC) has been estimated, but the results remain inconsistent and the point of consensus has not been reached. This study was first determined to evaluate the clinical effects of p53 expression in SCC of the sinonasal tract. Methods: According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement criteria, the potential literature was searched from diverse databases. The pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated to assess the strength of association between p53 expression and SNSCC. Results: Final 17 eligible studies were included in a total of 258 cases and 748 controls. The result of p53 expression was shown to be notably higher in SNSCC than in benign sinonasal papillomas and normal sinonasal mucosa (OR = 26.93, P < 0.001; OR = 39.79, P < 0.001; respectively). Subgroup analyses of ethnicity revealed that p53 expression had significant association with SNSCC in Asian and Caucasian populations in cancer versus benign sinonasal papillomas or normal sinonasal mucosa. The expression of p53 was notably higher in moderately or poorly differentiated SNSCC than in well-differentiated SNSCC (OR = 3.51, P = 0.021), while p53 expression was not associated with histological type. Conclusion: The results suggested that p53 overexpression may be correlated with the carcinogenesis and progression of SNSCC. The p53 gene may become a novel drug target of SNSCC. Additional studies on the correlation of p53 expression with clinicopathological features are needed. PMID:28328848

  20. Sinonasal myospherulosis and paraffin retention cysts suggested by CT: report of a case.

    PubMed

    Coulier, Bruno; Desgain, Olivier; Gielen, Isabelle

    2012-06-01

    Sinonasal myospherulosis is a foreign body reaction to lipid material used on nasal packing at the conclusion of paranasal sinus surgery. Rare cases have been sporadically reported. We report a case found in a 79-year-old female 8 months after functional endoscopic sinus surgery during which sinus cavities had been packed with gauze coated with Terra-Cortril (a paraffin-based tetracycline/steroid ointment). The preoperative diagnosis was suggested during CT of the paranasal sinuses by the presence of macroscopic paraffin retention cysts having a characteristic fat density. To our knowledge, our case represents the first report of sinonasal myospherulosis suggested by CT.

  1. The sinonasal communication in the horse: examinations using computerized three-dimensional reformatted renderings of computed-tomography datasets

    PubMed Central

    2014-01-01

    Background Sinusitis is a common disease in the horse. In human medicine it is described, that obstruction of the sinonasal communication plays a major role in the development of sinusitis. To get spatial sense of the equine specific communication ways between the nasal cavity and the paranasal sinuses, heads of 19 horses, aged 2 to 26 years, were analyzed using three-dimensional (3D) reformatted renderings of CT-datasets. Three-dimensional models were generated following manual and semi-automated segmentation. Before segmentation, the two-dimensional (2D) CT-images were verified against corresponding frozen sections of cadaveric heads. Results Three-dimensional analysis of the paranasal sinuses showed the bilateral existence of seven sinus compartments: rostral maxillary sinus, ventral conchal sinus, caudal maxillary sinus, dorsal conchal sinus, frontal sinus, sphenopalatine sinus and middle conchal sinus. The maxillary septum divides these seven compartments into two sinus systems: a rostral paranasal sinus system composed of the rostral maxillary sinus and the ventral conchal sinus and a caudal paranasal sinus system which comprises all other sinuses. The generated 3D models revealed a typically configuration of the sinonasal communication ways. The sinonasal communication started within the middle nasal meatus at the nasomaxillary aperture (Apertura nasomaxillaris), which opens in a common sinonasal channel (Canalis sinunasalis communis). This common sinonasal channel ramifies into a rostral sinonasal channel (Canalis sinunasalis rostralis) and a caudo-lateral sinonasal channel (Canalis sinunasalis caudalis). The rostral sinonasal channel ventilated the rostral paranasal sinus system, the caudo-lateral sinonasal channel opened into the caudal paranasal sinus system. The rostral sinonasal channel was connected to the rostral paranasal sinuses in various ways. Whereas, the caudal channel showed less anatomical variations and was in all cases connected to the

  2. Sinonasal Angiomatous Polyp: Evaluation With 2-Phase Helical Computed Tomography

    PubMed Central

    Ding, Changwei; Wang, Qiushi; Guo, Qiyong; Wang, Zhenhai; Lu, Xiaomei; Zhang, Jun

    2015-01-01

    Abstract Sinonasal angiomatous polyp (SAP) is a rare benign nontumorous lesion and previously considered lack of characteristic computed tomography (CT) findings. This study aimed to evaluate 2-phase helical CT for characterization of SAP. Twelve patients with pathologically confirmed SAP underwent 2-phase helical CT preoperatively. After injection of 80 mL contrast material at a rate of 3 mL/s, early and delayed phases were obtained with delays of 30 and 120 s, respectively. The degree and pattern of enhancement were visually analyzed. The attenuation changes were also analyzed quantitatively by measuring CT values and compared with those of the internal maxillary artery (IMA). All 12 cases showed vessel-like marked heterogeneous enhancement at both early and delayed phases. An irregular linear, nodular, and patchy enhancement pattern was found at the early phase, and enlarged and fused together, that is, progressive enhancement pattern was found at the delayed phase. There was no significant difference between the CT values of SAP and those of the IMA at the plain, arterial phase, and delayed phase (53 ± 6 Hounsfield units [HU] vs 56 ± 7 HU, 187 ± 56 HU vs 209 ± 71 HU, and 143 ± 22 HU vs 139 ± 19 HU, respectively, P = 0.361, 0.429, and 0.613, respectively). Vessel-like marked heterogeneous enhancement was a characteristic CT feature of SAP, and progressive enhancement on 2-phase helical CT could further convince the diagnosis. PMID:26200632

  3. IgG4-related disease in the sinonasal cavity accompanied by intranasal structure loss.

    PubMed

    Inoue, Akiko; Wada, Kota; Matsuura, Kentaro; Osafune, Hiroshi; Ida, Yutaro; Kosakai, Arifumi; Edamatsu, Hideo

    2016-02-01

    IgG4-related disease was recently proposed under the classification of systemic chronic inflammatory disease. In the field of otolaryngology, organ-specific diagnostic criteria have been established for the occurrence of this condition in the salivary glands, but not in the sinonasal cavity. Here we report a case involving a 70-year-old man with IgG4-related disease in the sinonasal cavity. The patient, with the chief complaint of nasal bleeding, first visited a physician. However, the patient experienced recurrent bleeding with intranasal structure loss and was subsequently referred to our hospital. His IgG4 level was elevated, and histopathological examination of a tissue sample obtained from the edematous sphenoid sinus showed increased IgG4-positive plasma cells and storiform fibrosclerosis. A definitive diagnosis of IgG4-related rhinosinusitis was made on the basis of comprehensive criteria for IgG4-related disease. The disease showed a progressively destructive course that was clearly different from that of chronic sinusitis and represented a very rare case of IgG4-related rhinosinusitis. IgG4-related disease originating in the sinonasal cavity is rare, and, to the best of our knowledge, this is the first primary case of IgG4-related disease that originated in one side of the sinonasal cavity and showed progressive destruction.

  4. Sinonasal Delivery of Resveratrol via Mucoadhesive Nanostructured Microparticles in a Nasal Polyp Mouse Model

    PubMed Central

    Lee, Mingyu; Park, Chun Gwon; Huh, Beom Kang; Kim, Se-Na; Lee, Seung Ho; Khalmuratova, Roza; Park, Jong-Wan; Shin, Hyun-Woo; Choy, Young Bin

    2017-01-01

    Resveratrol (RSV) has been shown to effectively suppress chronic rhinosinusitis with nasal polyps in a mouse model; however, when locally administered to the sinonasal cavity, bolus RSV is limited by low drug bioavailability owing to its low aqueous solubility and relatively rapid clearance from the administration site. To address this limitation, we propose mucoadhesive nanostructured microparticles (PLGA/PEG NM) as a potential carrier for the sinonasal delivery of RSV. In this study, PLGA/PEG NM released RSV in a sustained manner. Owing to the enlarged specific surface area of the nanostructures, PLGA/PEG NM had synergistically enhanced mucoadhesiveness and thus showed improved in vivo retention properties in the sinonasal cavity. Therefore, when tested in a mouse nasal polyp model, PLGA/PEG NM mitigated polyp formation and restored epithelial integrity better than the control treatments. The therapeutic effect was similar at half the dose of PLGA/PEG NM, suggesting improved local bioavailability of RSV in the sinonasal cavity. PMID:28071713

  5. Primary Clear Cell Microcystic Adenoma of the Sinonasal Cavity: Pathological or Fortuitous Association?

    PubMed Central

    Markham, Hannah; Theaker, Jeffery; Bateman, Adrian; Sommerlad, Matthew; Crawford, Gillian; Eccles, Diana

    2017-01-01

    Primary clear cell microcystic adenoma of the sinonasal cavity is rare. It has previously been described only as a VHL-associated tumour. Von Hippel-Lindau (VHL) syndrome is an inherited cancer syndrome characterised by an elevated risk of neoplasia including clear cell renal cell carcinoma (ccRCC), haemangioblastoma, and phaeochromocytoma. We describe the second reported case of a primary clear cell microcystic adenoma of the sinonasal cavity. The 39-year-old patient with VHL syndrome had previously undergone resection and ablation of ccRCC. He presented with epistaxis. Imaging demonstrated a mass in the ethmoid sinus. Initial clinical suspicion was of metastatic ccRCC. However, tumour morphology and immunoprofile were distinct from the previous ccRCC and supported a diagnosis of primary microcystic adenoma. Analysis of DNA extracted from sinonasal tumour tissue did not show loss of the wild-type allele at the VHL locus. Although this did not support tumour association with VHL disease, it was not possible to look for a loss-of-function mutation. The association of primary microcystic adenoma of the sinonasal cavity with VHL disease remains speculative. These lesions are benign but are likely to require regular surveillance. Such tumours may require repeated surgical excision. PMID:28261513

  6. Bone erosion caused by sinonasal cavernous hemangioma: CT findings in two patients.

    PubMed

    Kim, H J; Kim, J H; Kim, J H; Hwang, E G

    1995-05-01

    We report two cases of cavernous hemangioma originating in the sinonasal cavity. Although CT showed some enhancing areas within both tumors, the substantial bone destruction caused by these tumors made it difficult to differentiate them from the more common malignant epithelial tumors. Angiography was performed in one patient and showed characteristic pooling of contrast material.

  7. Sino-nasal T-cell lymphoma invading the brain: A case study

    PubMed Central

    Reddy, Srikanth; Kumar, Ashish; Allugolu, Rajesh; Uppin, Megha; Ramgopal, Keshav

    2014-01-01

    Lesions occupying the anterior cranial fossa may arise de novo or are extensions from the sino-nasal areas with a handful of differentials in either group. The imaging findings, though to a large extent standardized are not full proof. Primary central nervous system lymphoma and sino-nasal lymphoma are uncommon variants of extranodal non-Hodgkin's lymphoma (NHL). We encountered a 35-year-old lady presenting with headache and seizures with a mass lesion involving the ethmoids with invasion into the anterior cranial fossa diagnosed as T-cell extranodal NHL. Gross total resection and reconstruction of the skull base were done. She was treated with chemotherapy and radiotherapy and is doing well at 6 months follow-up. This is the first report of a sino-nasal T-cell lymphoma invading the brain-parenchyma in an immuno-competent person. Sino-nasal primary T-cell lymphoma presenting as skull base pathology should form an essential differential diagnosis along with other routine lesions of anterior cranial fossa. Since these lesions have a good response to chemo and radiotherapy, a trans-nasal biopsy may obviate the need of a craniotomy if neurosurgeons are aware of this rare entity. PMID:25685223

  8. Mulberry hypertrophy and accompanying sinonasal pathologies: A review of 68 cases.

    PubMed

    Akduman, Davut; Haksever, Mehmet; Yanilmaz, Muhammed; Solmaz, Fevzi

    2016-08-01

    Mulberry hypertrophy occasionally coexists with sinonasal pathologies. There are very few reports in the literature on this clinical entity. We conducted a retrospective study to draw attention to this condition in the context of accompanying sinonasal pathologies. Our study group was made up of 68 patients-51 males and 17 females, aged 13 to 57 years (mean: 34.9)-who had been diagnosed with mulberry hypertrophy and at least one accompanying sinonasal pathology. All patients had a long-standing chronic discharge. Forty-nine of these patients (72.1%) had unilateral mulberry hypertrophy. The most common concomitant pathologies were chronic rhinosinusitis and ostiomeatal complex disease; others included septal deviation, nasal polyposis, allergic rhinitis, and concha bullosa. Thirty-six patients (52.9%) with varying degrees of choanal/nasal obstruction were operated on with endoscopic excision to treat the mulberry hypertrophy. In all, most patients underwent some sort of surgery to treat either the mulberry hypertrophy or the accompanying sinonasal pathology. Based on our findings, we suggest a clinical staging system to serve as a way to standardize management and guide future basic and clinical research.

  9. [Influence of anatomic variations of the structures of the middle nasal meatus on sinonasal diseases].

    PubMed

    Buljcik-Cupić, Maja M; Savović, Slobodan N; Jovićević, Jasna S

    2008-01-01

    The most common anatomic variations of the structures of the middle nasal meatus are variations of agger nasi cells, variations of the middle turbinate, variations of uncinate process, variations of the ethmoidal bulla, deviations and deformations of nasal septum in the region of the middle nasal meatus, Haller's cell (orbitoethmoidal) and Onodi's cell (sphenoethmoidal cell). In 1997, the Otorhinolaryngology-Head Neck Surgery, Task Force on Chronic Rhinosinusitis defined chronic sinusitis and nasal disease initially by including sinusitis and rhinitis with one term-chronic rhinosinusitis. This was done because it was apparent to many that nasal disoders often affected the sinuses, and vice versa. Also they established baseline parameters, major and minor signs and symptoms, for definition of rhinosinusitis. Two major factors or one major factor and two minor factors constitute a strong history for rhinosinusitis. The following methods were used in the study: 1. Anamnestic data processing about: disease symptoms that were recognized by American Academy for ENT as major and minor criteria in diagnosing nosinusitis; the duration of symptoms; the kind of sinonasal disorder and the secondary disorders. 2. Data processing obtained by anterior/posterior rhinoscopy. 3. Data processing obtained by endoscopic examination. 4. Data processing obtained by CT of paranasal cavities and the nose. The data about anatomic variations were statistically processed by Eives's correlation coefficient that indicates the degree of correlation between sinonasal disorders and anatomic variation. By analyzing the obtained data in the examined patients with sinonasal disorders, anatomic variations were present in over 50% of the patients and are defined by percentage. 1. The deviation of nasal septum in 83.33% patients. 2. The variations of the form of the middle nasal chonha in 58.92% patients. 3. The presence of agger nasi cells in 50% patients. 4. Variations of the form of ethomoidal bulla

  10. Impact of saline irrigation and topical corticosteroids on the post-surgical sinonasal microbiota

    PubMed Central

    Liu, Cindy M.; Kohanski, Michael A.; Mendiola, Michelle; Soldanova, Katerina; Dwan, Michael G.; Lester, Richard; Nordstrom, Lora; Price, Lance B.; Lane, Andrew P.

    2015-01-01

    Introduction Topical treatments with nasal saline irrigation, topical steroid sprays, or corticosteroid rinses can improve sinonasal symptoms in chronic rhinosinusitis (CRS). However, the impact of these therapies on commensals (Corynebacterium) and on biofilm pathogens associated with CRS (Staphylococcus aureus and Pseudomonas) is not well characterized. Methods Paired nasal and sinus swabs were collected endoscopically from 28 controls and 14 CRS patients with nasal polyposis (CRSwNP) who had not received systemic antibiotics or corticosteroids in the previous eight weeks. Total DNA from swab eluents were extracted and analyzed by 16S rRNA gene-based pyrosequencing. A total 359,077 reads were obtained and classified taxonomically. The association of use of topical therapies with sinonasal microbiota composition was assessed by factor and vector-fitting. The proportional abundances of sinonasal bacteria between topical therapy users and non-users were further compared by two-tailed Kolmogorov-Smirnov test among controls and among CRSwNP participants. Result Nasal saline irrigation, with or without added budesonide, was not associated with significantly distinct sinonasal microbiota composition or significantly decreased Pseudomonas or S. aureus abundances among either controls or CRSwNP participants. Corynebacterium was slightly lower in controls that reported using saline irrigation than those who did not. No significant association was found between nasal saline irrigation and the proportional abundances of Pseudomonas, S. aureus, and Corynebacterium in CRSwNP participants. However, male CRSwNP patients were noted to have significantly higher Corynebacterium proportional abundances than their female counterparts. The use of topical steroid sprays was associated with a distinct microbiota in control subjects, characterized by higher proportional abundances of Dolosigranulum and Simonsiella and a lower proportional abundance of Campylobacter. Conclusion Nasal

  11. High-resolution microendoscope imaging of inverted papilloma and normal sinonasal mucosa: evaluation of interobserver concordance.

    PubMed

    Parasher, Arjun K; Kidwai, Sarah M; Schorn, Victor J; Goljo, Erden; Weinberg, Alan D; Richards-Kortum, Rebecca; Sikora, Andrew G; Iloreta, Alfred Marc; Govindaraj, Satish; Miles, Brett A

    2015-12-01

    High-resolution microendoscopy (HRME) enables real-time imaging of epithelial tissue. The utility of this novel imaging modality for inverted papilloma has not been previously described. This study examines the ability of otolaryngologists to differentiate between images of inverted papilloma and normal sinonasal mucosa obtained with a HRME. Inverted papilloma and normal sinonasal mucosa specimens were stained with a contrast agent, proflavine. HRME images were subsequently captured. Histopathological diagnosis was obtained for each sample. Quality-controlled images were used to assemble a training set. After reviewing the training images, 6 otolaryngologists without prior HRME experience reviewed and classified test images. Five samples of inverted papilloma and 2 normal sinonasal mucosa samples were collected. Four representative images from each specimen were used for the 28-image test set. The mean accuracy among all reviewers was 89.9% (95% confidence interval [CI], 84.3% to 94.0%). The sensitivity to correctly identify inverted papilloma was 86.7% (95% CI, 79.2% to 92.2%), and the specificity was 92.9% (95% CI, 89.0% to 100.0%). The Fleiss kappa interrater reliability score was 0.80 (95% CI, 0.70 to 0.89). Inverted papilloma and normal sinonasal mucosa have distinct HRME imaging characteristics. Otolaryngologists can be successfully trained to distinguish between inverted papilloma and normal sinonasal mucosa. HRME is a feasible tool for identification of inverted papilloma. By conducting future in vivo trials, HRME potentially may enable real-time surgical margin determination during surgical excision of inverted papilloma. © 2015 ARS-AAOA, LLC.

  12. Coplanar VMAT vs. noncoplanar VMAT in the treatment of sinonasal cancer.

    PubMed

    Zhong-Hua, Ning; Jing-Ting, Jiang; Xiao-Dong, Li; Jin-Ming, Mu; Jun-Chong, Mo; Jian-Xue, Jin; Ming, Gao; Qi-Lin, Li; Wen-Dong, Gu; Lu-Jun, Chen; Hong-Lei, Pei

    2015-01-01

    Previous studies showed that noncoplanar intensity-modulated radiotherapy (NC-IMRT) for sinonasal cancer is superior to coplanar intensity-modulated radiotherapy (IMRT). Volumetric-modulated arc therapy (VMAT) is a newly introduced treatment modality, and the performance of noncoplanar VMAT for sinonasal cancer has not been well described to date. To compare the dosimetry difference of noncoplanar VMAT (NC-VMAT), coplanar VMAT (co-VMAT), and NC-IMRT for sinonasal cancer. Ten postoperative patients with sinonasal cancer were randomly selected for planning with NC-VMAT, co-VMAT, and NC-IMRT. Two planning target volumes (PTVs) were contoured representing high-risk and low-risk regions set to receive a median absorbed dose (D50%) of 68 Gy and 59 Gy, respectively. The homogeneity index (HI), conformity index (CI), dose-volume histograms (DVHs), and delivery efficiency were all evaluated. Both NC-VMAT and co-VMAT showed superior dose homogeneity and conformity in PTVs compared with NC-IMRT. There was no significant difference between NC-VMAT and co-VMAT in PTV coverage. Both VMAT plans provided a better protection for organs at risk (OARs) than NC-IMRT plans, and NC-VMAT showed a small improvement over co-VMAT in sparing of OARs. For peripheral doses, the doses to breast, thyroid, and larynx in the NC-IMRT plans were significantly higher than those in both VMAT plans. Compared to NC-VMAT, co-VMAT significantly reduced peripheral doses. NC-VMAT and co-VMAT reduced the average delivery time by 63.2 and 64.2%, respectively, in comparison with NC-IMRT. No differences in delivery efficiency were observed between the two VMAT plans. Compared to NC-VMAT, co-VMAT showed similar PTV coverage and comparable OAR sparing but significantly reduced peripheral doses and positioning uncertainty. We propose to give priority to coplanar VMAT in the treatment of sinonasal cancer.

  13. Endoscopic Modified Transseptal Transsphenoidal Approach for Maximal Preservation of Sinonasal Quality of Life and Olfaction.

    PubMed

    Hong, Sang Duk; Nam, Do-Hyun; Kong, Doo-Sik; Kim, Hyo Yeol; Chung, Seung-Kyu; Dhong, Hun-Jong

    2016-03-01

    Patients experience significant postoperative sinonasal symptoms for the first few months after endoscopic transnasal transsphenoidal approach (ETN-TSA) surgery. We modified this technique by bypassing the nasal mucosa and approaching through the septum bilaterally. In this study, we analyze whether these technical modifications, which we have termed the endoscopic modified transseptal transsphenoidal approach (EMTS-TSA), decrease postoperative sinonasal morbidity after endoscopic TSA. We retrospectively reviewed a prospectively collected database. Patients who underwent endoscopic TSA from December 2012 to June 2014 were included. Thirty patients underwent ETN-TSA, and 51 underwent EMTS-TSA. Sino-Nasal Outcome Test-20, anterior skull base nasal inventory, and visual analog scale (VAS) for subjective olfaction were evaluated before and 1 and 3 months after surgery. Cross Cultural Smell Identification Test also was measured before and 3 months after surgery. There was a significant difference between the preoperative and 3-month VAS for olfaction in the ETN-TSA group (from 92.5 to 81.3; P = 0.002) but not the EMTS-TSA group (from 90.6 to 88.8; P = 0.403). There was no statistical difference in Sino-Nasal Outcome Test-20 or Cross-Cultural Smell Identification Test scores between 2 groups during follow-up. The EMTS-TSA group scored better than the ETN-TSA group in the anterior skull base nasal inventory subdomain ("nasal discharge," "urge to blow," and "trouble breading") 1 month postoperatively. EMTS-TSA could preserve almost all nasal mucosa, including the septum and turbinates. EMTS-TSA may be useful for preserving early postoperative olfactory function and some sinonasal quality of life. We believe that EMTS-TSA is a good endoscopic pituitary surgery option. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Incidental sinonasal findings identified during preoperative evaluation for endoscopic transsphenoidal approaches

    PubMed Central

    Laury, Adrienne M.; Oyesiku, Nelson M.; Hadjipanayis, Costas G.; DelGaudio, John M.

    2013-01-01

    Background: The endoscopic transsphenoidal approach (eTSA) to lesions of the sellar region is typically performed jointly by neurosurgeons and otolaryngologists. Occasionally, the approach is significantly altered by sinonasal disease, anatomic variants, or previous surgery. However, there are no current guidelines that describe which physical or radiological findings should prompt a change in the plan of care. The purpose of this study was to determine the incidence of sinonasal pathology or anatomic variants noted endoscopically or by imaging that altered preoperative or intraoperative management. Methods: A retrospective review was performed of 355 consecutive patients who underwent combined neurosurgery–otolaryngology endoscopic sella approach from August 1, 2007 to April 1, 2011. Our practice in these patients involves preoperative otolaryngology clinical evaluation and MRI review. Intraoperative image guidance is not routinely used in uncomplicated eTSA. Results: The most common management alteration was the addition of image guidance based on anatomic variants on MRI, which occurred in 81 patients (35.0%). Eight patients (2.9%) were preoperatively treated with antibiotics and surgery was postponed secondary to acute or chronic purulent rhinosinusitis; two (0.7%) required functional endoscopic sinus surgery for medically refractory disease before eTSA. Five patients (1.8%) required anterior septoplasty intraoperatively for severe nasal septal deviation. Two patients (0.7%) had inverted papilloma and one patient had esthesioneuroblastoma identified preoperatively during rigid nasal endoscopy. Conclusion: This is one of the larger reviews of patients undergoing eTSA for sellar lesions and the only study that describes how intraoperative management may be altered by preoperative sinonasal evaluation. We found a significant incidence of sinonasal pathology and anatomic variants that altered routine operative planning; therefore, a thorough sinonasal evaluation

  15. Ivacaftor and sinonasal pathology in a cystic fibrosis patient with genotype deltaF508/S1215N.

    PubMed

    Vreede, C L; Berkhout, M C; Sprij, A J; Fokkens, W J; Heijerman, H G M

    2015-05-01

    In patients with Cystic Fibrosis and a type III mutation, ivacaftor (Kalydeco(®), Vertex) can increase the opening time of the CFTR channel and improve chloride transport. Research showed significant improvement of lung function and increase in weight following ivacaftor use. However, ivacaftor showed to have adverse events on the sinonasal system as well, such as upper respiratory tract infections, nasal congestion and headaches. This case report showed a positive effect of ivacaftor on the sinonasal pathology in a 17 year old patient with CF. After 5 months of ivacaftor use, the CT-sinus showed complete resolution of the opacification of the paranasal sinuses and a decrease in symptoms of sinonasal disease. This positive effect of ivacaftor on sinonasal pathology seems promising, therefore more research is needed to evaluate the effect of ivacaftor on the upper airways in CF.

  16. Sinonasal solitary chemosensory cells "taste" the upper respiratory environment to regulate innate immunity.

    PubMed

    Lee, Robert J; Cohen, Noam A

    2014-01-01

    It is not fully understood how sinonasal epithelial cells detect the presence of pathogens and activate innate defense responses necessary for protecting the upper airway from infection. One mechanism is through bitter taste receptors (T2Rs), which are expressed in the sinonasal cavity. One T2R isoform, T2R38, is expressed in ciliated cells and detects quorum-sensing molecules from gram-negative bacteria, activating antimicrobial nitric oxide production. More recent studies have examined the role of T2Rs expressed in a sinonasal cell type that has only recently been identified in humans, the solitary chemosensory cell (SCC). We sought to provide an overview of SCCs and taste receptor function in human sinonasal defense as well as implications for chronic rhinosinusitis (CRS). A literature review of the current knowledge of SCCs and taste receptors in sinonasal physiology and CRS was conducted. Human sinonasal SCCs express both bitter T2R and sweet T1R2/3 receptors. Activation of SCC T2Rs activates a calcium signal that propagates to the surrounding epithelial cells and causes secretion of antimicrobial peptides. T1R2/3 sweet receptor activation by physiological airway surface liquid (ASL) glucose concentrations attenuates the T2R response, likely as a mechanism to prevent full activation of the T2R pathway except during times of infection, when pathogens may consume ASL glucose and reduce its concentration. SCCs appear to be important mediators of upper airway innate immunity, as the SCC T2Rs regulate antimicrobial peptide secretion, but further study is needed to determine the specific T2R isoforms involved as well as whether polymorphisms in these isoforms affect susceptibility to infection or patient outcomes in CRS. The inhibitory role of T1R2/3 sweet receptor suggests that T1R2/3 blockers may have therapeutic potential in some CRS patients, particularly those with diabetes mellitus. However, further clinical study of the relationship between infection and T1R2

  17. Efficacy of Nasal Mometasone for the Treatment of Chronic Sinonasal Disease in Inadequately Controlled Asthma

    PubMed Central

    Dixon, Anne E.; Castro, Mario; Cohen, Rubin I.; Gerald, Lynn B.; Holbrook, Janet T.; Irvin, Charles G.; Mohapatra, Shyam; Peters, Stephen P.; Rayapudi, Sobharani; Sugar, Elizabeth A.; Wise, Robert A.

    2014-01-01

    Background Chronic sinonasal disease is common in asthma and associated with poor asthma control; however there are no long term trials addressing whether chronic treatment of sinonasal disease improves asthma control. Objective To determine if treatment of chronic sinonasal disease with nasal corticosteroids improves asthma control as measured by the Childhood Asthma Control Test (cACT) and Asthma Control Test (ACT) in children and adults respectively. Methods A 24 week multi-center randomized placebo controlled double-blinded trial of placebo versus nasal mometasone in adults and children with inadequately controlled asthma. Treatments were randomly assigned with concealment of allocation. Results 237 adults and 151 children were randomized to nasal mometasone versus placebo, 319 participants completed the study. There was no difference in the cACT (difference in change with mometasone – change with placebo [ΔM - ΔP]: -0.38, CI: -2.19 to 1.44, p = 0.68 ages 6 to 11) or the ACT (ΔM - ΔP: 0.51, CI: -0.46 to 1.48, p = 0.30, ages 12 and older) in those assigned to mometasone versus placebo. In children and adolescents, ages 6 to 17, there was no difference in asthma or sinus symptoms, but a decrease in episodes of poorly controlled asthma defined by a drop in peak flow. In adults there was a small difference in asthma symptoms measured by the Asthma Symptom Utility Index (ΔM - ΔP: 0.06, CI: 0.01 to 0.11, p <0.01) and in nasal symptoms (sinus symptom score ΔM - ΔP: -3.82, CI: -7.19 to- 0.45, p =0.03), but no difference in asthma quality of life, lung function or episodes of poorly controlled asthma in adults assigned to mometasone versus placebo. Conclusions Treatment of chronic sinonasal disease with nasal corticosteroids for 24 weeks does not improve asthma control. Treatment of sinonasal disease in asthma should be determined by the need to treat sinonasal disease rather than to improve asthma control. PMID:25174863

  18. [The Role of microRNA in head and neck cancer focusing on sinonasal carcinoma].

    PubMed

    Kovaříková, Helena; Chmelařová, Marcela; Palička, Vladimír

    MicroRNAs are small (18-25 nt) noncoding RNA molecules that are part of gene expression regulation and influence tumorigenesis. They could possibly be used as biomarkers and therapeutic targets in cancer in the future.Head and neck cancer is the sixth most common malignancy worldwide. These also include sinonasal carcinoma, a rare disease arising in the epithelium of respiratory tract, which is very poorly studied from the molecular perspective.MicroRNAs that have influence on pathogenesis of head and neck tumors have been divided into three categories: microRNAs associated with invasiveness and metastatic processes, microRNAs operating as oncogenes and microRNAs associated with HPV status and smoking. We expect that the described microRNAs could be part of regulatory mechanisms also in sinonasal carcinoma.

  19. Exhaled nasal nitric oxide during humming: potential clinical tool in sinonasal disease?

    PubMed

    Maniscalco, Mauro; Pelaia, Girolamo; Sofia, Matteo

    2013-04-01

    The use of nasal nitric oxide (nNO) in sinonasal disease has recently been advocated as a potential tool to explore upper inflammatory airway disease. However, it is currently hampered by some factors including the wide range of measurement methods, the presence of various confounding factors and the heterogeneity of the study population. The contribution of nasal airway and paranasal sinuses communicating with the nose through the ostia represents the main confounding factor. There is accumulating evidence that nasal humming (which is the production of a tone without opening the lips or forming words) during nNO measurement increases nNO levels due to a rapid gas exchange in the paranasal sinuses. The aim of this review is to discuss the basic concepts and clinical applications of nNO assessment during humming, which represents a simple and noninvasive method to approach sinonasal disease.

  20. Undifferentiated sinonasal carcinoma in a patient with nevoid basal cell carcinoma syndrome.

    PubMed

    Sobota, Amy; Pena, Maria; Santi, Mariarita; Ali Ahmed, Atif

    2007-07-01

    Nevoid basal cell carcinoma syndrome is an autosomal dominant multisystem disorder characterized by developmental anomalies and occurrence of multiple basal cell carcinomas and other tumors in early childhood. In this article, the authors report a case of a 19-year-old African American male with nevoid basal cell carcinoma syndrome and a history of medulloblastoma at age 2, meningioma at age 14, thyroid follicular adenomas with papillary carcinoma at age 15, and 2 basal cell carcinomas at ages 16 and 18. Recently, he developed sinonasal undifferentiated carcinoma (SNUC). The radiology and pathology of the sinonasal carcinoma are presented in this report. Review of the literature reveals that this is the first case of SNUC occurring in a patient with nevoid basal cell carcinoma syndrome.

  1. Orbital apex syndrome due to trigeminal perineural spread of sinonasal leprosy: a case report.

    PubMed

    El Beltagi, Ahmed H; El-Nil, Hosam; Alrabiah, Lamia; El Shammari, Nofa

    2012-01-01

    Leprosy is a granulomatous disease primarily affecting the skin and peripheral nerves caused by Mycobacterium leprae, but also significantly involving sinonasal cavities and cranial nerves. It continues to be a significant public health problem, and despite multidrug therapy, it can still cause significant morbidity. The awareness of cranial nerve, intracranial and orbital apex involvement as in our case is important for appropriate treatment measures. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. (18)FDG PET/CT in Routine Surveillance of Asymptomatic Patients following Treatment of Sinonasal Neoplasms.

    PubMed

    Workman, Alan D; Glicksman, Jordan T; Parasher, Arjun K; Carey, Ryan M; Brooks, Steven G; Kennedy, David W; Nabavizadeh, Seyed A; Learned, Kim O; Palmer, James N; Adappa, Nithin D

    2017-08-01

    Objective Sinonasal neoplasms have a high rate of recurrence following treatment, and current guidelines support the use of a variety of surveillance techniques. Recent work demonstrates that performance parameters of surveillance modalities may differ with sinonasal tumors in particular when compared with head and neck tumors overall. This study aims to characterize the value of (18)fluorodeoxyglucose ((18)FDG) positron emission tomography/computed tomography (PET/CT) as a screening tool in asymptomatic patients. Study Design Retrospective cohort study. Setting Hospital of the University of Pennsylvania and Pennsylvania hospital. Methods Records of asymptomatic patients without suspicious endoscopy or suspicious imaging other than PET during the first 3 years following definitive treatment for sinonasal malignancy were screened and analyzed for inclusion in the cohort. Disease recurrence was determined by biopsy following suspicious PET evaluation. Results PET/CT scans (n = 111) were performed for 45 disease-free asymptomatic patients with no evidence of disease on endoscopy, and 6.3% were suspicious and prompted biopsy during this period, revealing 3 cases of disease recurrence. Overall specificity for PET/CT alone was 96.3% (95% CI, 90.7%-99.0%), with a negative predictive value of 99% (95% CI, 94.8%-100%). All recurrences were detected between 7 and 12 months, and all patients with true recurrence diagnosed by PET/CT had extrasinonasal involvement of tumor at the time of surgery. Conclusion We examined performance parameters of (18)FDG PET/CT in asymptomatic patients with no evidence of disease on endoscopy during the posttreatment period for sinonasal malignancy. The ability of PET/CT to detect recurrences that may be missed by structural imaging or endoscopy makes it a valuable tool for clinicians.

  3. Utility of apparent diffusion coefficient in characterization of different sinonasal pathologies.

    PubMed

    Taha, Mohamed S; El Fiky, Lobna M; Taha, Togan M; Sabra, Reda M; Youssef, Tamer A; Nada, Ihab M

    2014-01-01

    Sinonasal lesions are a heterogeneous group of lesions that span from a tumor to tumor-like nature. Characterization of such cases preoperatively can improve the surgical control and the overall outcome of these patients. In this prospective study, we aimed at evaluation of the role of apparent diffusion coefficient (ADC) in the differentiation between benign and malignant sinonasal lesions. All patients scheduled to have sinonasal surgical intervention at Ain Shams University Hospitals, Cairo, Egypt, were enrolled. Diffusion-weighted (DW) magnetic resonance imaging (MRI) with calculation of ADC were done for all cases. Radiologic findings were then compared with histologic findings, and the sensitivity, specificity, negative and positive predictive values (PPVs) of the conventional MRI, DW-MRI, and ADC value in differentiation of benign from malignant sinonasal lesions were then calculated. There were 59 patients with median age of 43 years old. There were 20 cases of inflammatory lesions, 16 cases of benign tumors, and 23 cases of malignant lesions. The ADC values of all cases ranged from 0.4 × 10(-3) to 2 × 10(-3) (median = 1.5 × 10(-3)). The median ADC value for the malignant lesions was 0.6 × 10(-3), whereas that for the inflammatory conditions was 1.6 × 10(-3) and that for the benign tumors was 1.5 × 10(-3) with a highly significant difference (p < .001). Analysis of the conventional MRI and DW-MRI to differentiate between malignant and benign lesions showed that the sensitivity, specificity, PPV, and negative predictive value (NPV) were 100%, 97%, 96%, and 100% and 91%, 97%, 95%, and 95%, respectively. DW-MRI did not add significantly to the information gained from conventional MRI. It should be considered complimentary only to standard MRI in uncertain cases when malignancy is still a concern.

  4. Long-term sinonasal outcomes of aspirin desensitization in aspirin exacerbated respiratory disease.

    PubMed

    Cho, Kyu-Sup; Soudry, Ethan; Psaltis, Alkis J; Nadeau, Kari C; McGhee, Sean A; Nayak, Jayakar V; Hwang, Peter H

    2014-10-01

    This study aimed to assess sinonasal outcomes in patients with aspirin exacerbated respiratory disease (AERD) undergoing aspirin desensitization following endoscopic sinus surgery (ESS). Case series with chart review. University hospital. A retrospective review of sinonasal outcomes was conducted for 30 AERD patients undergoing aspirin desensitization and maintenance therapy following ESS. Sinonasal outcomes were prospectively assessed by the Sinonasal Outcomes Test-22 (SNOT-22) and endoscopic polyp grading system. Data were collected preoperatively, 1 and 4 weeks postsurgery (before desensitization), and 1, 6, 12, 18, 24, and 30 months after aspirin desensitization. Twenty-eight of 30 patients (93.3%) successfully completed aspirin desensitization, whereas 2 of 30 (6.7%) were unable to complete desensitization due to respiratory intolerance. Of the 21 patients who successfully completed a minimum of 24 weeks of follow-up, 20 (95.2%) patients demonstrated sustained endoscopic and symptomatic improvement for a median follow-up period of 33 months. After surgical treatment but before desensitization, patients experienced significant reductions in SNOT-22 and polyp grade scores. In the first 6 months after aspirin desensitization, patients experienced further significant reductions in SNOT-22 scores, whereas polyp grade remained stable. The improvements in symptom endoscopic scores were preserved throughout the follow-up period after desensitization. No patients required additional sinus surgery. One patient had to discontinue aspirin therapy due to gastrointestinal side effects. No other adverse reactions to aspirin were noted. Aspirin desensitization following ESS appears to be a well-tolerated and effective adjunctive therapy for long-term control of nasal polyposis in patients with AERD. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  5. Endoscopic binostril versus transnasal transseptal microscopic pituitary surgery: Sinonasal quality of life and olfactory function.

    PubMed

    Hong, Sang Duk; Nam, Do Hyun; Seol, Ho Jun; Choi, Na Yeon; Kim, Hyo Yeol; Chung, Seung Kyu; Dhong, Hun Jong

    2015-01-01

    There have been few comparative studies on olfactory function and sinonasal-specific quality of life (QOL) after endoscopic or microscopic surgery using a transsphenoidal approach (TSA). A retrospective review of a prospectively collected database was performed. Thirty-five patients who underwent a transnasal endoscopic approach and 20 patients who underwent a transnasal transseptal microscopic approach for treatment of pituitary adenoma were evaluated. An anterior skull base (ASK) nasal inventory and a subjective visual analog scale (VAS) (0-100) for olfaction were evaluated before and at one and three months after surgery. A cross-cultural smell identification test (CC-SIT) and a butanol threshold test (BTT) were also measured before and three months after surgery. There was no significant difference in subjective olfaction or CC-SIT or BTT score between the endoscopic and microscopic groups. The microscopic group (11.35 ± 3.67 and 9.72 ± 2.54, respectively) showed better ASK nasal inventory outcomes at one and three months after surgery compared with the endoscopic group (14.00 ± 4.85 and 11.70 ± 3.28, respectively; p = 0.029 and 0.036, respectively) especially in the subdomains of "nasal crusting" and "urge to blow nose." Transnasal transseptal microscopic pituitary surgery confers a better early postoperative sinonasal QOL with a comparable olfactory outcome compared with the endoscopic approach. Although many believe that an endoscopic approach is less invasive, preservation of the sinonasal mucosa proves to be more important in terms of sinonasal QOL than use of an endoscope or microscope.

  6. Malignant triton tumour of the sinonasal tract: Case report and literature review☆

    PubMed Central

    Zakzouk, Abdulmajeed; Hammad, Fahad; Langlois, Olivier; Aziz, Moutaz; Marie, Jean-Paul; Choussy, Olivier

    2014-01-01

    INTRODUCTION The objective is to report a rare tumour of the sinonasal tract and conduct a literature review. Malignant triton tumour is a subtype of malignant schwannoma with rhabdomyoblastic differentiation. It is a very rare tumour, with only 15 reported cases involving the sinonasal region. PRESENTATION OF CASE Forty-seven years old female presented with a right-sided epistaxis, progressive right sided nasal obstruction and anosmia and a visible mass in the right nasal cavity. Imaging studies showed a mass extending from the piriform aperture to the nasopharynx in contact with the dura and the orbital content. The mass was biopsied and the result was consistent with malignant triton tumour. The patient refused the surgery at first so chemotherapy with MAID protocol was started. After the fourth course of chemotherapy the treatment was stopped due to patient intolerance and a thrombosis of the jugular vein. Patient then underwent surgery with frontal craniotomy and dural excision, endoscopic control was done at the end to insure a complete removal. The patient received Radiotherapy in the postoperative period (56 Greys). At 5 years of follow up the patient is doing fine with no signs of recurrence and normal ophthalmological findings. DISCUSSION Sixteen cases, including our case, have been reported to date in the literature. The mean age at presentation is 61 years. None of cases were associated with neurofibromatosis type 1. Eight patients were reported to be alive 5 years post-treatment, and 2 patients were reported to have died of the disease. The prognosis for triton tumours in the sinonasal tract is better than that for triton tumours in other locations. CONCLUSION Malignant triton tumour is a rare malignancy of the sinonasal tract. Otolaryngologists should be aware of this disease. The optimal treatment should include radical resection of the tumour. PMID:25123649

  7. The Olfactory Strip and Its Preservation in Endoscopic Pituitary Surgery Maintains Smell and Sinonasal Function

    PubMed Central

    Harvey, Richard J.; Winder, Mark; Davidson, Andrew; Steel, Tim; Nalavenkata, Sunny; Mrad, Nadine; Bokhari, Ali; Barham, Henry; Knisely, Anna

    2015-01-01

    Background The return of olfaction and of sinonasal function are important end points after pituitary surgery. Opinions differ on the impact of surgery because techniques vary greatly. A modified preservation of the so-called olfactory strip is described that utilizes a small nasoseptal flap and wide exposure. Methods A cohort of patients undergoing pituitary surgery and endoscopic sinonasal tumor surgery were assessed. Patient-reported outcomes (Sino-Nasal Outcome Test [SNOT22] and Nasal Symptom Score [NSS]) were recorded. A global score of sinonasal function and the impact on smell and taste were obtained. Objective smell discrimination testing was performed in the pituitary group with the Smell Identification Test. Outcomes were assessed at baseline and at 6 months. Results Ninety-eight patients, n = 40 pituitary (50.95 ± 15.31 years; 47.5% female) and n = 58 tumor (52.35 ± 18.51 years; 52.5% female) were assessed. For pituitary patients, NSSs were not significantly different pre- and postsurgery (2.75 ± 3.40 versus 3.05 ± 3.03; p = 0.53). SNOT22 scores improved postsurgery (1.02 ± 0.80 versus 0.83 ± 0.70; p = 0.046). Objective smell discrimination scores between baseline and 6 months were similar (31.63 ± 3.49 versus 31.35 ± 4.61; p = 0.68). No difference in change of olfaction was seen compared with controls (Kendall tau-b p = 0.46). Conclusions Preservation of the olfactory strip can provide a low morbidity approach without adversely affecting olfaction and maintaining reconstruction options. PMID:26682125

  8. Rhinoplasty from a rhinologist's perspective: Need for recognition of associated sinonasal conditions

    PubMed Central

    Picavet, Valerie A.; Grietens, Jente; Jorissen, Mark

    2012-01-01

    Background: Facial plastic surgeons may primarily focus on esthetic improvement of the nasal shape in patients seeking rhinoplasty (RP). However, medical conditions inside the nasal cavity should not be neglected because they may lead to unresolved sinonasal problems and, hence, dissatisfaction after esthetic RP. This observational study investigated the prevalence of sinonasal symptoms and endonasal pathology in patients requesting esthetic RP. Methods: Patients seeking RP (n = 269) were given a questionnaire evaluating nasal obstruction and sinonasal symptoms using visual analog scales and the 22-item Sino-Nasal Outcome Test. In addition, patients underwent nasal endoscopy to evaluate anatomic and/or mucosal disease and skin-prick testing in case of clinical suspicion of allergy. Two control groups consisted of patients with an otological or general ear/nose/throat problem (n = 65) and patients who planned for endoscopic sinus surgery (ESS; n = 90). Results: The general appraisal of nasal breathing on a scale from 0–10 in patients seeking RP was as low as 4.3 ± 3.1. Structural pathology was found in 62% of RP patients, with septal deviation being the most frequent problem encountered (54%), followed by internal nasal valve dysfunction (14%). Mucosal disease was present in 28% of RP patients. The mean SNOT-22 score of RP patients (31.8 ± 23.3) was significantly higher than the control group (11.6 ± 7.9; p < 0.001), but lower than the ESS patients (48.5 ± 22.0; p < 0.001). Conclusion: The prevalence of endonasal structural or mucosal pathology in patients seeking RP is high and should not be overlooked at the time of planning surgery. PMID:23232202

  9. Vibrational mapping of sinonasal lesions by Fourier transform infrared imaging spectroscopy

    NASA Astrophysics Data System (ADS)

    Giorgini, Elisabetta; Sabbatini, Simona; Conti, Carla; Rubini, Corrado; Rocchetti, Romina; Re, Massimo; Vaccari, Lisa; Mitri, Elisa; Librando, Vito

    2015-12-01

    Fourier transform infrared imaging (FTIRI) is a powerful tool for analyzing biochemical changes in tumoral tissues. The head and neck region is characterized by a great variety of lesions, with different degrees of malignancy, which are often difficult to diagnose. Schneiderian papillomas are sinonasal benign neoplasms arising from the Schneiderian mucosa; they can evolve into malignant tumoral lesions (squamous cell carcinoma). In addition, they can sometimes be confused with the more common inflammatory polyps. Therefore, an early and definitive diagnosis of this pathology is mandatory. Progressing in our research on the study of oral cavity lesions, 15 sections consisting of inflammatory sinonasal polyps, benign Schneiderian papillomas, and sinonasal undifferentiated carcinomas were analyzed using FTIRI. To allow a rigorous description of these pathologies and to gain objective diagnosis, the epithelial layer and the adjacent connective tissue of each section were separately investigated by following a multivariate analysis approach. According to the nature of the lesion, interesting modifications were detected in the average spectra of the different tissue components, above all in the lipid and protein patterns. Specific band-area ratios acting as spectral markers of the different pathologies were also highlighted.

  10. Prognostic value of Helicobacter pylori sinonasal colonization for efficacy of endoscopic sinus surgery.

    PubMed

    Jelavic, Boris; Grgić, Marko; Cupić, Hrvoje; Kordić, Mirko; Vasilj, Mirjana; Baudoin, Tomislav

    2012-10-01

    Compared with rhinologic patients without chronic rhinosinusitis (CRS), a higher prevalence of sinonasal Helicobacter pylori (HP) in patients with CRS was found. This study investigated if HP sinonasal colonization has a prognostic value for efficacy of functional endoscopic sinus surgery (FESS). Nasal polyps of 40 patients with CRS, undergoing FESS, were analyzed for presence of HP using immunohistochemistry (IHC). Patients were categorized as to whether the IHC was positive (HP+ group) or negative (HP- group). HP+ group and HP- group were compared according to the nasal polyp eosinophil density, and to the improvement (difference between pre- and post-operative scores) of the subjective symptom scores, and the nasal endoscopic scores. Nasal polyps in 28 (70%) patients were positive for HP. There were no significant differences between HP+ group and HP- group comparing the eosinophils, and the improvement of the single symptom and the total symptom scores. HP+ group had significantly greater improvement of the nasal endoscopic scores (F[1.38] = 6.212; P = 0.017). There is no influence of sinonasal HP on tissue eosinophilia and on CRS symptoms. There is a prognostic value for endonasal findings: CRS patients with HP have statistically significant greater improvement of the postoperative endoscopic scores.

  11. Clinical signs, treatment, and outcome in 15 cattle with sinonasal cysts.

    PubMed

    Schmid, Tanja; Braun, Ueli; Hagen, Regine; Grest, Paula; Hug, Sophie A; Nuss, Karl

    2014-02-01

    To evaluate clinical signs, diagnosis, treatment and outcome of cattle with sinonasal cysts. Case series. Cattle (n = 15). Medical records (2004-2011) of cattle with a fluid-filled mass in the nasal cavity, conchae, and/or paranasal sinuses were evaluated. Data retrieved and analyzed were reason of presentation, clinical signs, diagnostic techniques, surgical treatment, complications, and outcome. Common presenting clinical signs were abnormal respiratory noise, nasal discharge, and abnormal respiratory effort. Mean age of affected cattle was 21.7 months. In 9 animals, cysts were identified by endoscopy. Radiographic signs included a mass in the paranasal sinuses or conchae (13), nasal septum deviation (12), fluid lines (10), and bone atrophy (5). Ten cattle were treated surgically with osteoplastic flap techniques to gain access to the frontal or maxillary sinus (5), nasal extraction of the cyst under endoscopic control (3) or a combination of both techniques (2). Nine cattle returned to be productive members of their herd and had no recurrence (mean follow-up, 20.7 months). Sinonasal cysts should be considered as a primary differential diagnosis in cattle with abnormal respiratory noise, particularly in younger animals. Multiple cysts were common, which underlines the importance of a thorough preoperative examination using appropriate imaging modalities. Despite the often expansive nature of sinonasal cysts, the prognosis with surgical treatment was good. © Copyright 2014 by The American College of Veterinary Surgeons.

  12. Sinonasal Characteristics in Patients with Obstructive Sleep Apnea Compared to Healthy Controls

    PubMed Central

    Bugten, Vegard; Thorstensen, Wenche Moe; Nordgård, Ståle

    2017-01-01

    Background. The difference in nasal obstruction between OSA patients and healthy individuals is not adequately documented. Our aim was to describe the sinonasal quality of life and nasal function in OSA patients and healthy controls using the sinonasal outcome test-20 (SNOT-20), nasal obstruction visual analog scale (NO-VAS), and peak nasal inspiratory flow (PNIF). Methodology and Principal. Ninety-three OSA patients and 92 controls were included in a case-control study from 2010 to 2015. Results. Mean SNOT-20 score in the OSA group was 1.69 (SD 0.84) compared to 0.55 (SD 0.69) in controls (p < 0.001, 95% CI [0.9, 1.4]). The mean NO-VAS score was 41.3 (SD 12.8) and 14.7 (SD 14.4) in the OSA group and controls, respectively, (p < 0.001, 95% CI [22.7, 30.6]). PNIF measured 105 litres/minute in the OSA group and 117 litres/minute in controls (p < 0.01, 95% CI [−21.8, −3.71]). There was a positive correlation between subjective nasal obstruction and change in PNIF after decongestion in the control group alone. Conclusions. OSA patients have a reduced sinonasal QoL and lower peak nasal inspiratory flow compared to controls. Treatment of nasal obstruction in OSA patients should be made a priority along with treatment of the ailment itself. PMID:28546812

  13. Another CT sign of sinonasal polyposis: truncation of the bony middle turbinate.

    PubMed

    Liang, E Y; Lam, W W; Woo, J K; Van Hasselt, C A; Metreweli, C

    1996-01-01

    In order to study the features of sinonasal polyposis (SNP) on CT, 100 consecutive coronal sinus CT examinations done for chronic inflammatory sinonasal disease were reviewed. The CT findings of the 27 fully documented SNPs were analyzed. All our SNPs were bilateral. There was a strong tendency for extensive involvement. Nasal polyps were seen in 22 of 27(81%); bony trabecular deossification in 23 of 27 (85%); widening of infundibulum in 26 of 27 (96%). We discovered a new sign "truncation of the bony middle turbinate", where the bulbous part of bony middle turbinate was missing, in 15 of 26 (58%) of SNP patients without a previous history of middle turbinectomy, 12 of 15(80%) were bilateral. The one SNP patient (1 of 27) with previous middle turbinectomy was not regarded to be real truncation. Truncation of the bony middle turbinate is a characteristic and easily recognizable ancillary sign, and is not seen in other patterns of sinusitis. Together with other features on coronal sinus CT, this adds diagnostic confidence in diagnosing sinonasal polyposis.

  14. The presentation and clinical significance of sinonasal respiratory epithelial adenomatoid hamartoma (REAH).

    PubMed

    Hawley, Karen A; Pabon, Sheila; Hoschar, Aaron P; Sindwani, Raj

    2013-03-01

    Sinonasal respiratory epithelial adenomatoid hamartoma (REAH) is a benign glandular proliferation with ciliated epithelium. Little is known about REAH, with only a few published case reports appearing since its original description in 1995. Classically described as an isolated polypoid lesion arising from the nasal septum, more recent descriptions also suggest that REAH can occur among nasal polyps. We report the largest experience with REAH to date, and aim to better understand and characterize this unique entity. In this case series, all cases of REAH diagnosed between 2006 and 2011 were reviewed. Clinical presentation, histologic and radiographic features, and operative findings were examined. There were 45 patients 19 females and 26 males, with a mean age of 55.9 years (range, 23-83). Most cases of REAH (33/45, 73%) were found in association with another pathologic process (sinonasal polyposis, adenoiditis, hereditary hemorrhagic telangiectasia [HHT], inverted papilloma [IP], or malignancy). Of these, REAH occurring among diffuse polyposis (79% of cases) represented the large majority. The average Harvard computed tomography (CT) stage for this cohort was 3.1. The other presentation of REAH (12/45, 27%) was an isolated sinonasal mass. In cases of isolated REAH, the majority of lesions (75%) were noted to be originating in the olfactory clefts. Isolated REAH, which may mimic a neoplasm, appears to be a different clinical entity than the more common form encountered in association with nasal polyps and inflammation. Further investigation into the etiology and clinical significance is needed. © 2013 ARS-AAOA, LLC.

  15. Association between clinical characteristics, computed tomography characteristics, and histologic diagnosis for cats with sinonasal disease.

    PubMed

    Tromblee, Tonya C; Jones, Jeryl C; Etue, Ashley E; Forrester, S Dru

    2006-01-01

    The purpose of this retrospective study was to determine the association between clinical characteristics, computed tomography (CT) characteristics, and histologic diagnosis in 43 cats with sinonasal disease. All cats were evaluated with CT and nasopharyngeal endoscopic examination, with histologic diagnosis based on nasal biopsy. Fifteen cats were diagnosed with sinonasal neoplasia and 28 cats were diagnosed with rhinitis. Clinical characteristics determined to be significantly associated with neoplasia were unilateral ocular discharge (odds ratio [OR] 9.6) and the presence of a nasopharyngeal mass during endoscopic examination (OR 18.9). CT characteristics found to be significantly associated with neoplasia included: unilateral lysis of ethmoturbinates (OR 11.0), unilateral lysis of the dorsal (OR 8.3) and lateral maxilla (OR 6.9), lysis of the vomer bone (OR 6.7) and ventral maxilla (OR 28.8), and bilateral lysis of the orbital lamina (OR 4.1); unilateral abnormal soft tissue/fluid within the sphenoid sinus (OR 15.3), frontal sinus (OR 10.4), and/or and retrobulbar space (OR 12.2). Lysis of the maxillary turbinates, nasal septum, nasal bone, palatine bone, and cribriform plate were not significantly associated with sinonasal neoplasia.

  16. Pathogenetic Analysis of Sinonasal Teratocarcinosarcomas Reveal Actionable β-catenin Overexpression and a β-catenin Mutation.

    PubMed

    Birkeland, Andrew C; Burgin, Sarah J; Yanik, Megan; Scott, Megan V; Bradford, Carol R; McHugh, Jonathan B; McLean, Scott A; Sullivan, Stephen E; Nor, Jacques E; McKean, Erin L; Brenner, J Chad

    2017-08-01

    Objective  Sinonasal teratocarcinosarcomas are rare, aggressive tumors of the skull base. Treatment options are limited and outcomes are poor. Little is known in regard to the genetic factors regulating these tumors. Characterization of actionable molecular alterations in these tumors could provide potentially successful therapeutic options. Methods  We performed targeted exome sequencing on an index sinonasal teratocarcinosarcoma specimen to identify potential driver mutations. We performed immunohistochemical stains for β-catenin on paraffin-embedded tissue on the index tumor and a subsequent teratocarcinosarcoma. Online databases of cancer mutations (Catalogue of Somatic Mutations in Cancer and The Cancer Genome Atlas) were accessed. Results  We identified an activating p.S45F mutation in β-catenin in our index sinonasal teratocarcinosarcoma. This mutation results in constitutive signaling in the Wnt/β-catenin pathway. We confirmed β-catenin overexpression and nuclear localization via immunohistochemistry in the index tumor and a second patient. The p.S45F activating mutation was found in a variety of solid tumors, and accounts for 3.3 to 10.4% of all known β-catenin mutations. Conclusion  We identified a potential driver mutation in β-catenin in a sinonasal teratocarcinosarcoma, resulting in β-catenin overexpression. These findings suggest a role for the Wnt/β-catenin pathway in sinonasal teratocarcinosarcoma tumorigenesis and a role for anti-β-catenin targeted therapy.

  17. A long-term study of 277 cases of equine sinonasal disease. Part 1: details of horses, historical, clinical and ancillary diagnostic findings.

    PubMed

    Tremaine, W H; Dixon, P M

    2001-05-01

    The clinical and ancillary diagnostic findings in equine sinnasal disease were studied. The diagnoses in 277 referred (1984-1996) cases of equine sinonasal disease included the following (% all cases): 67 cases (24.2%) primary sinusitis, 61 (22.0%) dental sinusitis, 37 (13.4%) sinus cysts, 22 (7.9%) sinonasal neoplasia, 21 (7.6%) progressive ethmoid haematoma, 17 (6.1%) sinonasal trauma, 13 (4.7%) sinonasal mycosis, 11 (4.0%) rostral maxillary cheek tooth infection, 7 (2.5%) sinonasal polyps, 7 (2.5%) cases of nasal epidermal inclusion cysts and 14 (5.1%) miscellaneous sinonasal disorders. Many disorders showed similar clinical signs including nasal discharge (present in 88% of all cases) and facial swelling (46%). Most disorders were chronic, with a median duration of signs of 12 weeks (range 3 days- 6 years) prior to referral. Sinus cysts and sinonasal neoplasia were significantly (P<0.05) more frequently associated with gross distortion of the nasal passages and facial bones than the other sinonasal disorders. Endoscopic changes were detected per nasum in 91% of cases, but contributed to the exact diagnosis in only 20%. Radiography revealed abnormalities in 81% of cases but was diagnostically useful in only 36%. Sinoscopy was diagnostically useful in 70% of the 61 cases where used.

  18. Intensity-Modulated Radiotherapy for Sinonasal Tumors: Ghent University Hospital Update

    SciTech Connect

    Madani, Indira Bonte, Katrien; Vakaet, Luc; Boterberg, Tom; Neve, Wilfried de

    2009-02-01

    Purpose: To report the long-term outcome of intensity-modulated radiotherapy (IMRT) for sinonasal tumors. Methods and Materials: Between July 1998 and November 2006, 84 patients with sinonasal tumors were treated with IMRT to a median dose of 70 Gy in 35 fractions. Of the 84 patients, 73 had a primary tumor and 11 had local recurrence. The tumor histologic type was adenocarcinoma in 54, squamous cell carcinoma in 17, esthesioneuroblastoma in 9, and adenoid cystic carcinoma in 4. The tumors were located in the ethmoid sinus in 47, maxillary sinus in 19, nasal cavity in 16, and multiple sites in 2. Postoperative IMRT was performed in 75 patients and 9 patients received primary IMRT. Results: The median follow-up of living patients was 40 months (range, 8-106). The 5-year local control, overall survival, disease-specific survival, disease-free survival, and freedom from distant metastasis rate was 70.7%, 58.5%, 67%, 59.3%, and 82.2%, respectively. No difference was found in local control and survival between patients with primary or recurrent tumors. On multivariate analysis, invasion of the cribriform plate was significantly associated with lower local control (p = 0.0001) and overall survival (p = 0.0001). Local and distant recurrence was detected in 19 and 10 patients, respectively. Radiation-induced blindness was not observed. One patient developed Grade 3 radiation-induced retinopathy and neovascular glaucoma. Nonocular late radiation-induced toxicity comprised complete lacrimal duct stenosis in 1 patient and brain necrosis in 3 patients. Osteoradionecrosis of the maxilla and brain necrosis were detected in 1 of the 5 reirradiated patients. Conclusion: IMRT for sinonasal tumors provides low rates of radiation-induced toxicity without blindness with high local control and survival. IMRT could be considered as the treatment of choi0008.

  19. A systematic review of sinonasal oncocytomas and oncocytic carcinomas: Diagnosis, management, and technical considerations.

    PubMed

    Hodzic, Zerina; Rowan, Nicholas R; Kashiwazaki, Ryota; Willson, Thomas J; Wang, Eric W; Lee, Stella E

    2017-05-01

    Oncocytomas and oncocytic carcinomas are rare tumors of the sinonasal cavity with the propensity for local invasion. This report and systematic review details a case of a nasal oncocytoma involving the lacrimal sac and provides an update of the current literature. A systematic literature review was performed using PubMed and Ovid databases. The data obtained from published articles with sinonasal oncocytoma/oncocytic carcinoma as the primary diagnosis included patient demographics, presentation, radiographic and histologic findings, management, and recurrence rates. Twenty cases were identified. The most common symptoms were epistaxis (n = 11) and nasal obstruction (n = 11). Involvement of the nasal cavity was most common (n = 17), followed by the paranasal sinuses (n = 13) and nasolacrimal apparatus (n = 4). Recurrence occurred in 55% of cases. Recurrence was associated with invasion or infiltration found on histology or the presence of both invasion/infiltration and mitotic figures/pleomorphism (p < 0.05), with no significant relationship between recurrence and age at diagnosis (p = 0.42), sex (p = 0.65), and location of tumor (p = 0.14). The authors present the case of a 73-year-old woman with a 5-month history of worsening epistaxis and biopsy-proven oncocytoma. Complete surgical resection of the tumor using combined endonasal endoscopic and anterior orbitotomy approach is described. Oncocytomas and oncocytic carcinomas are rare tumors of the sinonasal cavity with a high rate of local recurrence and orbital involvement. Surgical resection is the treatment of choice and complete resection can be achieved with an endoscopic endonasal approach. © 2017 ARS-AAOA, LLC.

  20. Evaluation of a novel post operative treatment for sinonasal disease in the horse (1996-2007).

    PubMed

    Hart, S K; Sullins, K E

    2011-01-01

    Results of surgical treatment of sinonasal disease in horses have been reported previously; however, this paper describes the outcome of horses in which a specific post operative treatment protocol was used. The objectives of the study were to determine: 1) short- and long-term outcome; 2) complications; and 3) recurrence rates of different disease processes, when horses were treated with a specific treatment protocol. Medical records of horses presented for surgical treatment of sinonasal disease from 1996-2007 were reviewed. Results and duration of surgical exploration were recorded. Post operatively, the sinus flaps were re-opened with the horses standing and sedated. Number of horses requiring further treatment (debridement and/or lavage), median number of post operative days when the flap was re-opened, median number of times the flap was opened and median duration of hospitalisation were recorded. Short- and long-term survival and complication rates were determined. Ninety-one horses were included in the study. The sinus flaps were re-opened with the horses standing a median of 3 days post operatively. Thirty-nine horses (43%) required further treatment at this time and 89 horses (97%) survived to discharge. Incision infection was the most common complication encountered (29%). No horse required a blood transfusion. Recurrence rates were 5% for paranasal sinus cysts, 12% for progressive ethmoid haematoma and 50% for neoplasia. Rapid removal of the primary lesion followed by packing the sinuses and re-evaluating in the standing horse in a more controlled environment offers a safe and effective means to thoroughly assess and treat sinonasal disease. Surgical time, intraoperative haemorrhage, long-term complications and recurrence rates of paranasal sinus diseases treated via frontonasal or maxillary sinus flap may be reduced using this technique. © 2010 EVJ Ltd.

  1. Psychometric evaluation of the Sinonasal Outcome Test-16 and activity impairment assessment in acute bacterial sinusitis.

    PubMed

    Quadri, Nuz; Lloyd, Andrew; Keating, Karen N; Nafees, Beenish; Piccirillo, Jay; Wild, Diane

    2013-07-01

    To validate the Sinonasal Outcome Test-16 and Activity Impairment Assessment in patients with acute bacterial sinusitis. Data were used from a phase III clinical trial designed to evaluate the efficacy and safety of moxifloxacin 400 mg once daily for 5 consecutive days in the treatment of acute bacterial sinusitis. The psychometric properties and factor structure of the 2 measures were assessed. Participants were given the measures to self-complete using either a telephone voice response system or a paper-and-pencil format. Three hundred seventy-four patients with acute bacterial sinusitis were used in the analysis. Patients received either a placebo or 400 mg moxifloxacin once daily. Patients were then reviewed at test of cure and follow-up. All analyses were conducted on a combined sample of placebo and active treatment patients. The Sinonasal Outcome Test-16 was associated with minimal missing data at baseline but a higher proportion by test of cure. There was no evidence of floor or ceiling effects and no significant skew. The Activity Impairment Assessment also had low missing data at baseline and no obvious floor or ceiling effects, but the data were not normally distributed. Both measures had good internal consistency. Convergent and divergent validity as well as sensitivity and the minimally important difference are also reported. The measures both have good psychometric properties and are suitable for use with patients with acute bacterial sinusitis. Both instruments are sensitive. The minimal important difference estimates for the Sinonasal Outcome Test-16 are quite high but are similar to estimates reported previously.

  2. In vitro effects of anthocyanidins on sinonasal epithelial nitric oxide production and bacterial physiology

    PubMed Central

    Hariri, Benjamin M.; Payne, Sakeena J.; Chen, Bei; Mansfield, Corrine; Doghramji, Laurel J.; Adappa, Nithin D.; Palmer, James N.; Kennedy, David W.; Niv, Masha Y.

    2016-01-01

    Background: T2R bitter taste receptors play a crucial role in sinonasal innate immunity by upregulating mucociliary clearance and nitric oxide (NO) production in response to bitter gram-negative quorum-sensing molecules in the airway surface liquid. Previous studies showed that phytochemical flavonoid metabolites, known as anthocyanidins, taste bitter and have antibacterial effects. Our objectives were to examine the effects of anthocyanidins on NO production by human sinonasal epithelial cells and ciliary beat frequency, and their impact on common sinonasal pathogens Pseudomonas aeruginosa and Staphylococcus aureus. Methods: Ciliary beat frequency and NO production were measured by using digital imaging of differentiated air-liquid interface cultures prepared from primary human cells isolated from residual surgical material. Plate-based assays were used to determine the effects of anthocyanidins on bacterial swimming and swarming motility. Biofilm formation and planktonic growth were also assessed. Results: Anthocyanidin compounds triggered epithelial cells to produce NO but not through T2R receptors. However, anthocyanidins did not impact ciliary beat frequency. Furthermore, they did not reduce biofilm formation or planktonic growth of P. aeruginosa. In S. aureus, they did not reduce planktonic growth, and only one compound had minimal antibiofilm effects. The anthocyanidin delphinidin and anthocyanin keracyanin were found to promote bacterial swimming, whereas anthocyanidin cyanidin and flavonoid myricetin did not. No compounds that were tested inhibited bacterial swarming. Conclusion: Results of this study indicated that, although anthocyanidins may elicited an innate immune NO response from human cells, they do not cause an increase in ciliary beating and they may also cause a pathogenicity-enhancing effect in P. aeruginosa. Additional studies are necessary to understand how this would affect the use of anthocyanidins as therapeutics. This study emphasized the

  3. Assessment of Abdominal Fat Graft to Repair Anterior Skull Base after Malignant Sinonasal Tumor Extirpation.

    PubMed

    Fonmarty, David; Bastier, Pierre-Louis; Lechot, Amandine; Gimbert, Edouard; de Gabory, Ludovic

    2016-03-01

    Adult abdominal fat, which is known to contain pluripotent stem cells, is frequently used to treat cerebrospinal fluid leak. The aim of this study was to assess the efficacy and reliability of abdominal fat graft to close large skull base defects after extirpation of malignant sinonasal tumors. Case series with chart review performed between 2009 and 2014. Twenty-nine cases were included of consecutive patients who were suffering from malignant sinonasal tumors, operated by an endoscopic endonasal approach with anterior skull base extirpation and surgically induced cerebrospinal fluid leak. Skull base was repaired by 1 layer of "en bloc" autologous fat graft used as a plug in the onlay position. Epidemiologic data, medical history, defect size, length of hospitalization, and morbidity were analyzed. Radiotherapy was given pre- and postoperatively in 4 (13.8%) and 23 (79.3%) patients, respectively. Mean defect size was 4.47 ± 2.9 cm(2) (range, 0.24-9.1 cm(2)). Mean operative time was 210 ± 86 minutes. Mean length of hospitalization was 8.6 ± 3.7 days and 4.9 ± 2 days in the intensive care unit. No lumbar drain was used in this study. There was 1 case of cerebrospinal fluid leak (3.5%) and 2 cases of meningitis (6.9%), which resolved after medical treatment. Mean follow-up was 17 ± 13 months (range, 3-53 months). Abdominal fat graft is a safe and reliable material to close the anterior skull base after extirpation of malignant sinonasal tumors. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  4. IMRT for Sinonasal Tumors Minimizes Severe Late Ocular Toxicity and Preserves Disease Control and Survival

    SciTech Connect

    Duprez, Frederic; Madani, Indira; Morbee, Lieve; Bonte, Katrien; Deron, Philippe; Domjan, Vilmos; Boterberg, Tom; De Gersem, Werner; De Neve, Wilfried

    2012-05-01

    Purpose: To report late ocular (primary endpoint) and other toxicity, disease control, and survival (secondary endpoints) after intensity-modulated radiotherapy (IMRT) for sinonasal tumors. Methods and Materials: Between 1998 and 2009, 130 patients with nonmetastatic sinonasal tumors were treated with IMRT at Ghent University Hospital. Prescription doses were 70 Gy (n = 117) and 60-66 Gy (n = 13) at 2 Gy per fraction over 6-7 weeks. Most patients had adenocarcinoma (n = 82) and squamous cell carcinoma (n = 23). One hundred and one (101) patients were treated postoperatively. Of 17 patients with recurrent tumors, 9 were reirradiated. T-stages were T1-2 (n = 39), T3 (n = 21), T4a (n = 38), and T4b (n = 22). Esthesioneuroblastoma was staged as Kadish A, B, and C in 1, 3, and 6 cases, respectively. Results: Median follow-up was 52, range 15-121 months. There was no radiation-induced blindness in 86 patients available for late toxicity assessment ({>=}6 month follow-up). We observed late Grade 3 tearing in 10 patients, which reduced to Grade 1-2 in 5 patients and Grade 3 visual impairment because of radiation-induced ipsilateral retinopathy and neovascular glaucoma in 1 patient. There was no severe dry eye syndrome. The worst grade of late ocular toxicity was Grade 3 (n = 11), Grade 2 (n = 31), Grade 1 (n = 33), and Grade 0 (n = 11). Brain necrosis and osteoradionecrosis occurred in 6 and 1 patients, respectively. Actuarial 5-year local control and overall survival were 59% and 52%, respectively. On multivariate analysis local control was negatively affected by cribriform plate and brain invasion (p = 0.044 and 0.029, respectively) and absence of surgery (p = 0.009); overall survival was negatively affected by cribriform plate and orbit invasion (p = 0.04 and <0.001, respectively) and absence of surgery (p = 0.001). Conclusions: IMRT for sinonasal tumors allowed delivering high doses to targets at minimized ocular toxicity, while maintaining disease control and survival

  5. Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes.

    PubMed

    Battaglia, P; Turri-Zanoni, M; De Bernardi, F; Dehgani Mobaraki, P; Karligkiotis, A; Leone, F; Castelnuovo, P

    2016-06-01

    Over the past decade surgery for sinonasal malignancies encroaching into the anterior skull base (ASB) has evolved from open craniofacial resection to the use of minimally invasive transnasal endoscopic approaches. Using these techniques, ASB reconstruction is most often performed in a multilayer fashion with autologous free grafts (fascia lata or iliotibial tract) which leads to the production of abundant nasal crusting in the postoperative months and discomfort for patients. In carefully selected cases, we propose harvesting a flap from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries (Septal Flip Flap, SFF), which can be rotated to resurface the ASB defect. The exclusion criteria for using the SFF were as follows: cases where the tumour extended to both ethmoid complexes; cases where there was nasal septum or planum spheno-ethmoidalis involvement by the disease; cases of sinonasal malignant tumour with multifocal histology. In our tertiary care referral centre, skull base reconstruction using the SFF was performed in four patients; one was affected by ethmoidal teratocarcinosarcoma, one by persistence of sinonasal undifferentiated carcinoma after radio-chemotherapy, another by olfactory cleft esthesioneuroblastoma and the fourth by ethmoidal squamous cell carcinoma. Successful skull base reconstruction was obtained in all four cases without any intra- or post-operative complications. Post-operatively, nasal crusting was significantly reduced with faster healing of the surgical cavity. No recurrences of disease have been observed after a mean follow-up of 15 months. The SFF can be considered as a safe and effective technique for ASB reconstruction with high success rates similar to those obtained with other pedicled flaps. This flap also ensured a faster healing process with reduction of nasal crusting and improvement in the quality of life of patients in the postoperative period. This technique appears

  6. Sinonasal carcinoma presenting as chronic sinusitis and sequential bilateral visual loss

    PubMed Central

    Chiang, Wei-Yu; Chen, Meng-Hsiang; Huang, Hsiu-Mei

    2015-01-01

    Sinonasal undifferentiated carcinoma-related rhinogenic optic neuropathy is rare and may lead to visual loss. To the best of our knowledge, this is the first report of bilateral sequential visual loss induced by this etiology. It is important to differentiate between chronic sinusitis and malignancy on the basis of specific findings on magnetic resonance images. Surgical decompression with multidisciplinary therapy, including steroids, chemotherapy, and radiotherapy, is indicated. However, no visual improvement was noted in this case, emphasizing the rapid disease progression and importance of early diagnosis and treatment. PMID:26265644

  7. The first case of feline sinonasal aspergillosis due to Aspergillus fischeri in Japan.

    PubMed

    Kano, Rui; Takahashi, Tomoko; Hayakawa, Takeshi; Yamaya, Yoshiki; Hasegawa, Atsuhiko; Kamata, Hiroshi

    2015-09-01

    Feline upper respiratory tract infection due to Aspergillus spp. is considered an emerging disease, with the number of reported cases continuing to rise. In this study, we report the first case of feline sinonasal aspergillosis caused by Aspergillus fischeri in Japan. The patient presented after 2 months of progressive facial deformity around the nose and nasal discharge. The isolate from this case was susceptible to itraconazole (ITZ), voriconazole and micafungin, but was resistant to amphotericine B. However, the infected cat died approximately 1 month after referral, despite treatment for 12 days ITZ administered orally at 10 mg/kg.

  8. The Role of Robotic Surgery in Sinonasal and Ventral Skull Base Malignancy.

    PubMed

    Hachem, Ralph Abi; Rangarajan, Sanjeet; Beer-Furlan, Andre; Prevedello, Daniel; Ozer, Enver; Carrau, Ricardo L

    2017-04-01

    Over the past decade, robotic surgery has gained wide popularity, making a significant impact on multiple surgical specialties. In the head and neck arena, transoral robotic surgery has proven to be safe and associated with acceptable oncological and superior functional outcomes for surgery of the oropharynx, hypopharynx, supraglottis, and glottis; thus, changing the paradigm for the management of tumors in these anatomic locations. Robotic surgery of the ventral skull base is at an early stage of development. In this article reviews the literature discussing the role of robotic surgery in managing sinonasal and ventral skull base malignant lesions.

  9. Small round blue cell tumors of the sinonasal tract: a differential diagnosis approach.

    PubMed

    Thompson, Lester Dr

    2017-01-01

    One of the most challenging diagnostic categories within tumors of the sinonasal tract is the small round blue cell tumors. Biopsies are usually small and limited, resulting in considerable diagnostic difficulty for practicing surgical pathologists. These tumors share several overlapping histologic and immunophenotypic findings while also showing considerable variation within and between cases. Specific tumor site of origin, imaging findings, and clinical findings must be combined with the histology and pertinent ancillary studies if the correct diagnosis is to be reached. Discrimination between neoplasms is critical as there are significant differences in therapy and overall outcome. It is important to have a well developed differential diagnosis for this category of tumors, where each of the diagnoses is considered, evaluated, and either confirmed or excluded from further consideration. In an undifferentiated tumor, showing a small round blue cell morphology, using the mnemonic 'MR SLEEP' helps to highlight tumors to consider: melanoma, mesenchymal chondrosarcoma, rhabdomyosarcoma, sinonasal undifferentiated carcinoma, squamous cell carcinoma (including NUT carcinoma), small cell osteosarcoma, lymphoma, esthesioneuroblastoma (olfactory neuroblastoma), Ewing sarcoma/primitive neuroectodermal tumor, pituitary adenoma, and plasmacytoma. A panel of pertinent immunohistochemistry studies, histochemistries and/or molecular tests should aid in reaching a diagnosis, especially when taking the pattern and intensity of reactions into consideration.

  10. Unusual sinonasal small-cell neoplasms following radiotherapy for bilateral retinoblastomas

    SciTech Connect

    Frierson, H.F. Jr.; Ross, G.W.; Stewart, F.M.; Newman, S.A.; Kelly, M.D. )

    1989-11-01

    Two patients developed sinonasal small-cell neoplasms that arose 22 years and 37 years, respectively, following radiotherapy for bilateral retinoblastomas. The tumors were composed of small cells with scant cytoplasm and had a few scattered Homer-Wright rosettes. Immunohistochemically, one tumor was positive for keratin (CAM 5.2 and AE1/AE3), epithelial membrane antigen, and neuron-specific enolase. The other neoplasm was immunoreactive for keratin (CAM 5.2 only) and neuron-specific enolase; it also had focal immunopositivity for S-100 protein, desmin, and muscle-specific actin. Both were negative for CEA, vimentin, melanocyte-specific antigen (HMB45), chromogranin A, synaptophysin, Leu-7, 200 kd neurofilament, and retinal S-antigen. Despite aggressive multimodal therapy, the patients died of metastatic tumor 7 months and 10 months following their initial diagnosis, respectively. Although osteosarcoma is the most frequent second cancer following bilateral retinoblastomas, some patients develop clinically aggressive sinonasal small-cell tumors that are difficult to place into conventional classifications. Both of our cases showed evidence of multidirectional differentiation; one tumor labeled with epithelial and neural markers, and the other expressed epithelial, neural, and myogenous antigens.49 references.

  11. Survival in unresectable sinonasal undifferentiated carcinoma treated with concurrent intra-arterial cisplatin and radiation

    PubMed Central

    Noticewala, Sonal S; Mell, Loren K; Olson, Scott E; Read, William

    2015-01-01

    We report the successful use of RADPLAT to treat a patient with an unresectable T4N0 sinonasal undifferentiated carcinoma. This patient received 4 cycles of weekly intra-arterial cisplatin together with thiosulfate infusion with concurrent radiation therapy. Radiation therapy was given in 28 daily fractions to 54 Gy using intensity-modulated radiation therapy followed by a hypofractionated stereotactic boost of 3 fractions to 13 Gy to a total dose of 67 Gy in 31 fractions to the nasal sinus and bilateral neck. Intra-arterial cisplatin was administered using a bilateral approach due to the midline site of this tumor. Within days of the first intra-arterial cisplatin, there was an obvious decrease in tumor size. She has been followed with magnetic resonance imaging and positron emission tomography, and remains disease-free 47 mo post-treatment. Centers with expertise in intra-arterial chemotherapy could consider the RADPLAT approach for patients with unresectable sinonasal undifferentiated carcinoma. PMID:25685767

  12. An Extremely Rare Case of Advanced Metastatic Small Cell Neuroendocrine Carcinoma of Sinonasal Tract.

    PubMed

    Thar, Yu Yu; Patel, Poras; Huang, Tiangui; Guevara, Elizabeth

    2016-01-01

    Small cell neuroendocrine carcinoma (SNEC) is a rare form of malignancy. It mainly presents as bronchogenic neoplasm, and the extrapulmonary form accounts for only 0.1% to 0.4% of all cancers. These extrapulmonary tumors have been described most frequently in the urinary bladder, prostate, esophagus, stomach, colon and rectum, gall bladder, head and neck, cervix, and skin. Primary SNEC of the sinonasal tract is extremely rare with only less than 100 cases reported in the literature. Because of extreme rarity and aggressiveness of the tumor, the management for this entity varies considerably mandating multimodality approach. In this paper, we report a patient presented with left-sided facial swelling, and the histopathologic examination confirmed primary SNEC of left sinonasal tract. The tumor involved multiple paranasal sinuses with invasion into the left orbit and left infratemporal fossa and metastasized to cervical lymph nodes and bone. The patient encountered devastating outcome in spite of optimal medical management and treatment with palliative chemotherapy highlighting the necessity for further research of primary SNEC of head and neck.

  13. An Extremely Rare Case of Advanced Metastatic Small Cell Neuroendocrine Carcinoma of Sinonasal Tract

    PubMed Central

    Guevara, Elizabeth

    2016-01-01

    Small cell neuroendocrine carcinoma (SNEC) is a rare form of malignancy. It mainly presents as bronchogenic neoplasm, and the extrapulmonary form accounts for only 0.1% to 0.4% of all cancers. These extrapulmonary tumors have been described most frequently in the urinary bladder, prostate, esophagus, stomach, colon and rectum, gall bladder, head and neck, cervix, and skin. Primary SNEC of the sinonasal tract is extremely rare with only less than 100 cases reported in the literature. Because of extreme rarity and aggressiveness of the tumor, the management for this entity varies considerably mandating multimodality approach. In this paper, we report a patient presented with left-sided facial swelling, and the histopathologic examination confirmed primary SNEC of left sinonasal tract. The tumor involved multiple paranasal sinuses with invasion into the left orbit and left infratemporal fossa and metastasized to cervical lymph nodes and bone. The patient encountered devastating outcome in spite of optimal medical management and treatment with palliative chemotherapy highlighting the necessity for further research of primary SNEC of head and neck. PMID:27529044

  14. Clinico-pathological profile of sinonasal masses: a study from a tertiary care hospital of India.

    PubMed

    Lathi, A; Syed, M M A; Kalakoti, P; Qutub, D; Kishve, S P

    2011-12-01

    The present study examined the clinico-pathological profile of sinonasal masses in patients attending an Ear Nose Throat clinic of a rural tertiary care hospital of western Maharashtra in India, between May 2007 to June 2009. During the study period, 112 patients presented with sinonasal masses (male 68, female 44; age group 8-70 years). Nasal polyploid masses were non-neoplastic in 80 (71.4%) subjects, and neoplastic in 32 (28.6%) cases. Nasal obstruction was the most common (97.3%) presenting complaint, followed by rhinorrhoea (49.1%), hyposmia (31.25%), intermittent epistaxis (17.9%), headache (16.9%), facial swelling (11.6%) and eye-related symptoms (10.7%). The most common site of origin of polyploid masses was the middle meatus (54.4%) followed by the lateral wall of the nasal cavity (16.1%) and superior meatus (10.7%). Unilateral nasal masses was present in 47.7% patients, while the remaining patients had bilateral nasal masses. Allergic (62.5%) and inflammatory (25%) polyps were the most common non-neoplastic mass. Haemangioma (47.3%) and inverted papilloma (36.8%) were most common benign neoplastic mass; 92.3% of all malignant masses were squamous cell carcinoma. Surgery was the major mode of treatment. It included Caldwell-Luc operation (7.1%), polypectomy (17.8%), excision of mass (25.0%) and functional endoscopic sinus surgery (44.6%). Malignancies were treated with radiotherapy.

  15. Nodal recurrence of sinonasal cancer: does the risk of cervical relapse justify a prophylactic neck treatment?

    PubMed

    Mirghani, Haïtham; Hartl, Dana; Mortuaire, Geoffrey; Armas, Gian Luca; Aupérin, Anne; Chevalier, Dominique; Lefebvre, Jean Louis

    2013-04-01

    Sinonasal cancers are rare and no high-level evidence exists to determine their optimal management. Prophylactic neck treatment issue remains controversial. The aim of this study was to analyze the pattern of neck failure and to identify any prognostic factors that may influence neck control. A retrospective review of 155 consecutive patients treated for sinonasal malignancy, without prophylactic neck treatment, between 1995 and 2005 at tertiary cancer center was performed. Demographic, clinical, morphological and pathological parameters were correlated with oncologic outcomes. Eight out of 155 patients (5%) presented initially with neck node metastasis. Complete remission was obtained for 133 patients after treatment completion. During follow up, 16 out of 133 patients (12%) were affected with regional recurrence. Neck failure occurred in 8 out of 51 patients with local failure and in 8 out of 82 patients locally controlled. Isolated nodal failure was observed in 5 patients initially cN0 out of 133 (3.8%) representing 7.3% of all recurrences and 3 of them underwent successful salvage therapy. None of the tested factors were significantly associated with neck control (p>0.05). Lymph node at diagnosis time was significantly and independently associated with poor survival (p=0.0012). Isolated neck relapse, when local control is achieved, is rare and salvage treatment is effective. Routine prophylactic neck treatment has little interest. However, this approach could be profitable to few selected patients, who remain to be defined. Further investigations are needed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Psychometric Validation of a Moroccan Version of the 22-Item Sino-Nasal Outcome Test.

    PubMed

    Adnane, Choaib; Adouly, Taoufik; Oubahmane, Tarek; Zouak, Abdelhay; Rouadi, Sami; Abada, Reda Lah; Roubal, Mohamed; Mahtar, Mohamed

    2016-10-01

    The objective of this study paper was to culturally adapt and validate the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire for Moroccan Arabic speaking patients. Prospective cohort study. Tertiary referral center; Ibn Rochd University Hospital, Casablanca, Morocco. The SNOT-22 was conducted in patients with chronic rhinosinusitis (CRS) undergoing sinonasal surgery and in healthy volunteers, from January 2012 to December 2013. It was translated into Moroccan Arabic language. To evaluate this questionnaire, internal consistency, test-retest reliability, responsiveness to treatment, and validity were analyzed. Preoperative SNOT-22 scores were completed by 88 patients. Six-month postoperative SNOT-22 scores were available for 74 patients. The Cronbach's alpha coefficient for the SNOT-22 was 0.968, indicating high internal consistency. The test-retest reliability coefficient was 0.993, indicating high reliability when administering the instrument on repeated occasions. The Moroccan version of the SNOT-22 was able to highly discriminate between patients with CRS and group of healthy volunteers (P < .0001). There was a statistically significant reduction in patient reported SNOT-22 scores at 6 months after surgery (P < .0001). The present study has found the Moroccan version of SNOT-22 to be valid and easy to use with good reliability, validity, and responsiveness. It can be used to measure the impact of CRS on the patient's quality of life and may also be used to evaluate CRS treatment. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  17. Sinonasal symptom assessment by the self-reported DyNaChron questionnaire: Before or after consultation?

    PubMed

    Nguyen, D T; Rumeau, C; Felix-Ravelo, M; Nguyen-Thi, P-L; Jankowski, R

    2017-02-01

    Assessment of sinonasal symptoms on a self-reported questionnaire is thoroughly subjective, but indispensable for quantifying symptoms. The present study sought to compare responses on the DyNaChron questionnaire just before and just after consultation for chronic sinonasal dysfunction. 78 patients (mean age, 43.1±16.9 years) consulting for chronic sinonasal dysfunction took part in a prospective study, responding to the computerized version of the DyNaChron self-reported questionnaire, in a dedicated room, just before and just after medical interview and physical examination. Most patients tended to grade symptoms as less severe after consultation. Significant differences in mean score were found for nasal obstruction (difference of 0.94/10), anterior (0.40) and posterior rhinorrhea (0.26), olfactory disorder (0.65), and facial pain and headache (0.65), but not for chronic cough. Self-reported scores for chronic sinonasal dysfunction differ slightly from before to after consultation. They are therefore to be interpreted with caution, taking account of possible factors of bias. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. The role of endothelial nitric oxide synthase (eNOS) in the pathogenesis of sinonasal polyps.

    PubMed

    Muluk, N Bayar; Arikan, O K; Atasoy, P; Kiliç, R; Yalçinozan, E Tuna

    2014-01-01

    The pathogenesis of sinonasal polyps has not been known completely. We investigated the role of endothelial Nitric Oxide Synthase (eNOS) in the pathogenesis of sinonasal polyps. Study group (Groups 1-3) consisted of nasal polyp samples of patients with sinonasal polyps; and control group consisted of inferior turbinate samples of patients without nasal polyp. In Group 1: 14 specimens from ethmoid sinus; in Group 2: 10 specimens from nasal cavity; in Group 3: 10 specimens from maxillary sinus; and in Group 4 (Control): 9 specimens from inferior turbinate were included. By immunohistochemical staining technique, eNOS Positivity Index in mucosal layers; and in the inflammatory cells were assessed. eNOS Positivity Index was higher at apical layer of epithelium; and perivascular and glandular parts of subepithelial layer. As a rate of mononuclear cells increased, eNOS positivity increased at basal part of epithelium. In eNOS Positivity Index of mononuclear cells increased ones, eNOS values also increased at glands of subepithelial layer. In nasal cavity, eNOS positivity index of all cells was significantly higher than that of the control group. Increased eNOS all cells positivity index values were seen with decreased glandular and endothelial eNOS values. In all cells group, fibroblasts were seen beside the mononuclear cells. It was observed that eNOS was not expressed in PMNC (mainly neutrophils), growing more in acute inflammatory process; and was expressed in MNCs and all cells group with fibroblasts which were the cells of chronic inflammatory process. Especially MNCs and fibroblasts may play a role in the polyp formation process. In males and in patients with longer polyp duration, eNOS values decreased. We concluded that eNOS Positivity Index was higher at apical layer of epithelium; and perivascular and glandular parts of subepithelial layer. eNOS plays role in vascular dilatation, increases in vascular permeability; increases in nasal secretion due to glandular

  19. A case-control study on occupational risk factors for sino-nasal cancer

    PubMed Central

    d’Errico, A; Pasian, S; Baratti, A; Zanelli, R; Alfonzo, S; Gilardi, L; Beatrice, F; Bena, A; Costa, G

    2009-01-01

    Objectives: Sino-nasal cancer has been consistently associated with exposure to wood dust, leather dust, nickel and chromium compounds; for other occupational hazards, the findings are somewhat mixed. The aim of this study was to investigate the risk of sino-nasal epithelial cancer (SNEC) by histological type with prior exposure to suspected occupational risk factors and, in particular, those in metalworking. Methods: Between 1996 and 2000, incident cases were collected on a monthly basis from hospitals throughout the Piedmont region of Italy by the regional Sino-nasal Cancer Registry. A questionnaire on occupational history, completed by 113 cases and 336 hospital controls, was used to assign exposure to occupational hazards. The relationship between SNEC and cumulative exposure to these hazards was explored using unconditional logistic regression to statistically adjust for age, sex, smoking and co-exposures, allowing for a 10-year latency period. Results: The risk of adenocarcinoma was significantly increased with ever-exposure to wood dust (odds ratio; OR = 58.6), and to leather dust (OR = 32.8) and organic solvents (OR = 4.3) after controlling for wood dust, whereas ever-exposure to welding fumes (OR = 3.7) and arsenic (OR = 4.4) significantly increased the risk for squamous cell carcinoma. For each of these hazards, a significant increasing trend in risk across ordered cumulative exposure categories was found and, except for arsenic, a significantly increased risk with ever-exposure at low intensity. Treating cumulative exposure on a continuous scale, a significant effect of textile dusts was also observed for adenocarcinoma. For a mixed group of other histological types, a significant association was found with wood dust and organic solvents. Conclusions: Some occupational risk factors for SNEC were confirmed, and dose–response relationships were observed for other hazards that merit further investigation. The high risk for

  20. IgG4-related disease presenting with destructive sinonasal lesion mimicking malignancy.

    PubMed

    Chen, Bo-Nien

    2016-11-01

    IgG4-related disease is a newly recognized systemic fibroinflammatory disorder. We report a 36-year-old man who presented with intractable right nasal pain and frontal headache for 1 month. Computed tomography revealed an ill-defined lesion with bony erosion over the right anterior ethmoid sinus and middle turbinate. The lesion was resected through endoscopic anterior ethmoidectomy and middle turbinectomy. IgG4-related disease was definitively diagnosed according to histopathological features. Prednisolone was administered postoperatively. IgG4-related disease presenting with destructive sinonasal lesion mimicking malignancy is rare. Awareness is essential to avoid delayed diagnosis or unnecessary invasive intervention, because the disorder responds to glucocorticoid and immunosuppressant therapy.

  1. [Sinonasal carcinoma and exposure to wood and leather dust: analysis of 36 cases].

    PubMed

    Bracci, M; Mariotti, L; Staffolani, S; Strafella, E; Carlucci, C; Pasquini, E; Tarchini, P; Re, M; Santarelli, L

    2012-01-01

    In order to define the best strategies of prevention and diagnosis of sinonasal cancer, the aim of our study was the investigation of the etiological and prognostic factors related to 36 cases. The enrolled cases were composed mostly of men working in the footwear industry, with a mean age of 63.7 years and mean exposure of 34.6 years. The period between the start of exposure and the appearance of the neoplasm was of 44.6 years, the time between the onset of symptoms and diagnosis was of 10.8 months. Our results suggest that a diagnosis within 6 months after the onset of symptoms is associated with a lower tumor stage, a better survival and to a lower rate of recurrence. Nasal obstruction (58.3%) and epistaxis (52.7%) are the main initial symptoms. In order to obtain an early diagnosis, in addition to periodic clinical controls, a proper information of workers is required.

  2. Sinonasal characteristics and quality of life by SNOT-22 in adult patients with cystic fibrosis.

    PubMed

    Kang, Suzie Hyeona; Meotti, Camila Degen; Bombardelli, Karine; Piltcher, Otávio Bejzman; de Tarso Roth Dalcin, Paulo

    2017-04-01

    The prevalence of chronic sinus disease in cystic fibrosis (CF) has gradually increased. Sinonasal involvement may have influence on pulmonary exacerbations and can have a negative impact on the quality of life. To evaluate nasal characteristics and quality of life in adult patients with CF; to establish an association and determine the predictors in SNOT-22 questionnaire. Cross- sectional study with prospective data collection was performed to evaluate adult CF patients. Patients underwent clinical evaluation, lung function tests, nasal endoscopy, and paranasal sinuses CT scan. All the patients answered the SNOT-22 questionnaire. A total of 91 patients were allocated, of which, 45.1% were male. Patients were divided into three groups by SNOT-22. A high average age, late age of diagnosis, rhinitis symptoms, and clinical criteria for rhinosinusitis were observed more frequently in patients with high SNOT-22 scores (p < 0.05). Overall, 84.6% patients had abnormal CT findings, with aplasia/hypoplasia of the sphenoid sinus being the most common finding. In multiple regression model, age, female gender, and Pseudomonas aeruginosa in the sputum were associated with high SNOT-22 scores in the nasal domain. Hyposmia and lack of medial bulging of lateral nasal wall were variables associated with high SNOT-22 scores in the quality of life domain. In total score, there was a positive association with age and the presence of P. aeruginosa in sputum. Despite high prevalence of abnormal tomographic findings, patients reported mild intensity of sinonasal symptoms. Advanced age and the presence of P. aeruginosa were associated with higher SNOT-22 scores.

  3. Utility of novel 3-dimensional stereoscopic vision system for endoscopic sinonasal and skull-base surgery.

    PubMed

    Manes, R Peter; Barnett, Sam; Batra, Pete S

    2011-01-01

    The objective of this pilot study was to evaluate the utility of novel 3-dimensional (3D) endoscopy during endoscopic sinonasal and skull base surgery. Eight surgeries were performed in 7 patients between August 2009 and March 2010 at a tertiary care academic medical center. A high-definition 2-dimensional (2D) endoscopy system was employed in all cases. The Visionsense stereoscopic system (Orangeburg, NY) was incorporated during key portions of the procedures. Two independent surgeons assessed utility of the technology for the following 2 variables: (1) ability to facilitate orientation and depth perception; and (2) impact on completeness of surgery and potential complications. The mean age was 50.4 years and the male:female ratio was 6:1. Indications included anterior skull base (ASB) tumor resection (5), directed skull base biopsies (2), and ethmoid dissection adjacent to dehiscent skull base/optic nerve in allergic fungal rhinosinusitis (1). Endoscopic orientation and depth perception was aided using the 3D endoscope in all cases. Additional interventions were performed in 3 cases (37.5%), including tumor resection (1) and removal of remnant ethmoid partitions (2). Limitations posed included inability to visualize a type III frontal cell (1) and loss of orientation during ASB reconstruction due to overmagnification (1). No complications were observed in this patient series. This preliminary study demonstrated the effectiveness of binocular 3D endoscopy during sinonasal and skull-base surgery. The technology facilitated depth perception and completeness of surgery without increase in complications. Additional experience is warranted to define its role in the endoscopic surgical paradigm. Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

  4. Fusion gene profile of biphenotypic sinonasal sarcoma: an analysis of 44 cases.

    PubMed

    Fritchie, Karen J; Jin, Long; Wang, Xiaoke; Graham, Rondell P; Torbenson, Michael S; Lewis, Jean E; Rivera, Michael; Garcia, Joaquin J; Schembri-Wismayer, David J; Westendorf, Jennifer J; Chou, Margaret M; Dong, Jie; Oliveira, Andre M

    2016-12-01

    Biphenotypic sinonasal sarcoma (SNS) is a locally aggressive tumour that occurs in the sinonasal region. PAX3-MAML3 has recently been identified as a recurrent fusion gene event in this entity; however, a subset of tumours harbour alternative PAX3 rearrangement without the involvement of MAML3. In this study we sought to characterize the molecular profile of a large series of cases, with a special emphasis on tumours with alternative fusions. Forty-four examples of SNS were screened by fluorescence in-situ hybridization and reverse transcription polymerase chain reaction to better characterize its molecular profile and identify potential novel fusion genes. Twenty-four were positive for PAX3-MAML3 (55%), 15 showed rearrangements of PAX3 without MAML3 involvement (34%), one showed rearrangement of MAML3 without PAX3 involvement, and four were negative for the involvement of either gene (9%). Among 15 cases with PAX3 involvement only, three were found to harbour PAX3-FOXO1. Two of these cases arose in the nasal cavities of female patients (aged 31 and 47 years), and one showed bilateral involvement of the nasal cavities of a 35-year-old male. A fourth case involved the skull base of a 47-year-old male, and was positive for PAX3-NCOA1. Patients with fusion-negative tumours were slightly older. More than half of the SNSs in this series were positive for PAX3-MAML3. However, a subset of tumours may harbour alternative PAX3 fusion genes or show no involvement of PAX3. Except for a possible weak association between age and molecular profile, the overall morphological and immunophenotypic features of all cases seem to be similar. Because of the rarity of these tumours, the impact of the molecular profile on the clinical course of these tumours remains to be determined. © 2016 John Wiley & Sons Ltd.

  5. Hepatocyte Growth Factor Gene-Modified Mesenchymal Stem Cells Augment Sinonasal Wound Healing

    PubMed Central

    Li, Jing; Li, Yong; Yang, Chen; Lin, Hai; Duan, Hong-Gang

    2015-01-01

    This study was designed to investigate the effects of hepatocyte growth factor (HGF) transgenic mesenchymal stem cells (HGF-MSCs) on wound healing in the sinonasal mucosa and nasal epithelial cells (NECs). We also sought to determine whether HGF-MSCs and MSCs can migrate into the injured mucosa and differentiate into ciliated cells. Human HGF-overexpressing umbilical cord MSCs (hHGF-UCMSCs) were established, and upregulation of hHGF expression was confirmed by real-time PCR (RT-PCR) and enzyme-linked immunosorbant assay (ELISA). To investigate the paracrine effect of human MSCs (hMSCs) on nasal epithelial repair, hMSC- and HGF-MSC-conditioned media (CM) were used in NEC proliferation assays and in an in vitro scratch-wound repair model. The in vivo sinonasal wound-healing model was established, and all enrolled rabbits were randomly assigned to four groups: the GFP-MSC group, the HGF-MSC group, the Ad-HGF group, and the surgery control group. The average decreased diameter was recorded, and the medial wall of the maxillary sinus was removed for histological analysis and scanning electron microscopy. Collagen deposition in the wound tissue was detected via Masson trichrome (M&T) staining. The distribution of MSCs and HGF-MSCs was observed by immunofluorescence. MSCs improved nasal wound healing both in vivo and in vitro. HGF overexpression in MSCs augmented the curative effects. Reduced collagen deposition and transforming growth factor beta1 (TGF-β1) expression were detected in the HGF-MSC group compared with the MSC-, Ad-HGF-, and phosphate-buffered saline-treated groups based on M&T staining and ELISA. The enhanced therapeutic effects of HGF-MSCs were accompanied by decreased level of the fibrogenic cytokine TGF-β1. In addition, both HGF-MSCs and MSCs can migrate to the injured mucosa and epithelial layer. PMID:25835956

  6. Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis.

    PubMed

    Barrs, V R; Beatty, J A; Dhand, N K; Talbot, J J; Bell, E; Abraham, L A; Chapman, P; Bennett, S; van Doorn, T; Makara, M

    2014-08-01

    Feline upper respiratory tract aspergillosis (URTA) occurs as two distinct anatomical forms, namely, sino-nasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA). An emerging pathogen, Aspergillus felis, is frequently involved. The pathogenesis of URTA, in particular the relationship between the infecting isolate and outcome, is poorly understood. In this study, computed tomography was used to investigate the route of fungal infection and extension in 16 cases (SNA n = 7, SOA n = 9) where the infecting isolate had been identified by molecular testing. All cases had nasal cavity involvement except for one cat with SNA that had unilateral frontal sinus changes. There was a strong association between the infecting species and anatomic form (P = 0.005). A. fumigatus infections remained within the sino-nasal cavity, while cryptic species infections were associated with orbital and paranasal soft-tissue involvement and with orbital lysis. Cryptic species were further associated with a mass in the nasal cavity, paranasal sinuses or nasopharynx. Orbital masses showed heterogeneous contrast enhancement, with central coalescing hypoattenuating foci and peripheral rim enhancement. Severe, cavitated turbinate lysis, typical of canine SNA, was present only in cats with SNA. These findings support the hypothesis that the nasal cavity is the portal of entry for fungal spores in feline URTA and that the route of extension to involve the orbit is via direct naso-orbital communication from bone lysis. Additionally, a pathogenic role for A. wyomingensis and a sinolith in a cat with A. udagawae infection are reported for the first time.

  7. CT findings of sinonasal respiratory epithelial adenomatoid hamartoma: a closer look at the olfactory clefts.

    PubMed

    Hawley, K A; Ahmed, M; Sindwani, R

    2013-05-01

    Respiratory epithelial adenomatoid hamartoma is a benign glandular neoplasm of the sinonasal cavities, which presents in isolation (REAHi) or in the setting of an adjacent inflammatory process such as sinonasal polyps. It is frequently found in the olfactory clefts. CT features of the 2 clinical presentations have not been well defined. We present the CT findings of REAH, focusing on the degree of associated sinusitis and changes in the OCs. We hypothesized that widening of the OCs and associated severity of the sinusitis are diagnostic features of REAH, differentiating it from SNP. In this case-control study, we compared patients with REAHi, those with REAH in the setting of SNP (REAHsnp), and those with SNP only (control patients). Patients with REAH were excluded if they had an adjacent inflammatory process other than SNP or if they did not have disease in the OC. We analyzed Harvard sinus CT scores and OC dimensions. A total of 29 patients with REAH were included: 7 with REAHi and 22 with REAHsnp. A total of 26 control patients were identified. Patients with REAHi had significantly lower Harvard CT scores than did the other groups. The OC width and the ratio of OC to the total nasal distance were significantly larger in both REAH groups compared with those of the control patients. If the OC is 10 mm or more, the sensitivity and specificity for the presence of REAH are 88% and 74%, respectively. Both clinical presentations of REAH are associated with OC widening on CT scan. In the setting of polypoid disease, an OC width of > 10 mm should increase suspicion for the presence of REAH.

  8. Carbon ion therapy for advanced sinonasal malignancies: feasibility and acute toxicity

    PubMed Central

    2011-01-01

    Purpose To evaluate feasibility and toxicity of carbon ion therapy for treatment of sinonasal malignancies. First site of treatment failure in malignant tumours of the paranasal sinuses and nasal cavity is mostly in-field, local control hence calls for dose escalation which has so far been hampered by accompanying acute and late toxicity. Raster-scanned carbon ion therapy offers the advantage of sharp dose gradients promising increased dose application without increase of side-effects. Methods Twenty-nine patients with various sinonasal malignancies were treated from 11/2009 to 08/2010. Accompanying toxicity was evaluated according to CTCAE v.4.0. Tumor response was assessed according to RECIST. Results Seventeen patients received treatment as definitive RT, 9 for local relapse, 2 for re-irradiation. All patients had T4 tumours (median CTV1 129.5 cc, CTV2 395.8 cc), mostly originating from the maxillary sinus. Median dose was 73 GyE mostly in mixed beam technique as IMRT plus carbon ion boost. Median follow- up was 5.1 months [range: 2.4 - 10.1 months]. There were 7 cases with grade 3 toxicity (mucositis, dysphagia) but no other higher grade acute reactions; 6 patients developed grade 2 conjunctivits, no case of early visual impairment. Apart from alterations of taste, all symptoms had resolved at 8 weeks post RT. Overall radiological response rate was 50% (CR and PR). Conclusion Carbon ion therapy is feasible; despite high doses, acute reactions were not increased and generally resolved within 8 weeks post radiotherapy. Treatment response is encouraging though follow-up is too short to estimate control rates or evaluate potential late effects. Controlled trials are warranted. PMID:21466696

  9. Association of Krouse Classification for Sinonasal Inverted Papilloma With Recurrence: A Systematic Review and Meta-analysis.

    PubMed

    Lisan, Quentin; Moya-Plana, Antoine; Bonfils, Pierre

    2017-09-28

    The risk factors for the recurrence of sinonasal inverted papilloma are still unclear. To investigate the potential association between the Krouse classification and the recurrence rates of sinonasal inverted papilloma. The EMBASE and MEDLINE databases were searched for the period January 1, 1964, through September 30, 2016, using the following search strategy: (paranasal sinuses [Medical Subject Headings (MeSH) terms] OR sinonasal [all fields]) AND (inverted papilloma [MeSH terms] OR (inverted [all fields] AND papilloma [all fields]). The inclusion criteria were (1) studies including sinonasal inverted papilloma only and no other forms of papillomas, such as oncocytic papilloma; (2) minimum follow-up of 1 year after the surgery; and (3) clear report of cases (recurrence) and controls according to the Krouse classification system or deducible from the full-text article. Literature search was performed by 2 reviewers. Of the 625 articles retrieved in the literature, 97 full-text articles were reviewed. Observational cohort studies or randomized controlled trials were included, and the following variables were extracted from full-text articles: authors of the study, publication year, follow-up data, and number of cases (recurrence) and controls (no recurrence) in each of the 4 stages of the Krouse classification system. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed. Odds ratios (ORs) and 95% CIs were estimated, and data of included studies were pooled using a random-effects model. The main outcome was recurrence after surgical removal of sinonasal inverted papilloma according to each stage of the Krouse classification system. Thirteen studies comprising 1787 patients were analyzed. A significant increased risk of recurrence (51%) was highlighted for Krouse stage T3 disease when compared with stage T2 (pooled OR, 1.51; 95% CI, 1.09-2.09). No significant difference in risk of recurrence was found between Krouse stages T1

  10. Sinonasal teratocarcinosarcoma involving nasal cavity, nasopharynx, and all paranasal sinuses with bilateral orbital and intracranial extension: A rare case report

    PubMed Central

    Kurmi, Dhruba Jyoti; Mittal, Radhey Shyam; Sharma, Achal; Gandhi, Ashok; Singhvi, Shashi

    2017-01-01

    Sinonasal teratocarcinosarcoma (SNTCS) is one of the rarest, aggressive malignant neoplasms of sinonasal tract, consisting of primitive neuroepithelial elements with various malignant epithelial and mesenchymal components. Previously described as teratoid carcinosarcoma, malignant teratoma, or blastoma, SNTCS constitutes less than 1% of all cancers and approximately 3% of all malignancies of head and neck region, which is mainly located in the nasal cavity and paranasal sinuses, although tumors occurring in other locations including the nasopharynx and oral cavity have been described. Here, we are presenting a 22-year-old patient with SNTCS involving the nasal cavity, nasopharynx, and all paranasal sinuses with bilateral orbital and intracranial extension treated with surgery followed by radiotherapy and chemotherapy. PMID:28484539

  11. The aerodynamics of the sinonasal interface: the nose takes wing-a paradigm shift for our time.

    PubMed

    Gungor, Anil A

    2013-04-01

    Ventilation of and gas exchange between the nose and the paranasal sinuses are believed to occur by convection and diffusion based on experiments that neglect the effects of physiological respiration and aerodynamic forces at the sinonasal interface (SNI). Based on these experiments, the exchange of gas is presumed to be slow, and principally dependent on gas concentration and diameter, number, and location of ostia. In 12 healthy adult volunteers, real-time sinus nitric oxide measurements were obtained with catheters placed through natural ostia during respiratory maneuvers. The nose is a masterful collection of aerodynamic foils and channels designed to accomplish powered sinonasal gas exchange and ventilation within a few seconds during each inspiration. The new perspective on the functional anatomy of the SNI demands a paradigm shift that is followed by physiological, medical, and surgical implications and a radical change in our perception and understanding. © 2013 ARS-AAOA, LLC.

  12. Long-term changes in quality of life after endoscopic resection of sinonasal and skull-base tumors.

    PubMed

    Derousseau, Taylor; Manjunath, Lakshman; Harrow, Brian; Zhang, Song; Batra, Pete S

    2015-12-01

    Minimally invasive endoscopic resection (MIER) has emerged as the new standard for surgical treatment of sinonasal and skull-base tumors. The objective of the present study was to evaluate quality of life (QOL) 2 years after MIER. Prospective 20-item Sino-Nasal Outcome Test (SNOT-20) data was accrued on 104 patients over 4 years. The study cohort included 72 patients with sinonasal malignancy, while 32 patients with inverted papilloma (IP) served as controls. The overall and rhinologic subdomain SNOT-20 scores for cancer patients did not statistically improve at 2 years (p = 0.12). They had statistically significant improvement in the psychological subdomain scores at 1 year (p = 0.03) and 2 years (p = 0.03). Similarly, the sleep subdomain scores improved at 1 year (p = 0.04) and 2 years (p = 0.03). In contrast, IP patients had statistically significant improvement in overall SNOT-20 (p = 0.01), rhinologic (p = 0.01), and sleep (p = 0.05) subdomain scores at 6 months, which remained stable at 2 years. Analysis of various factors demonstrated that history of prior smoking adversely affected QOL scores in cancer patients, with higher total SNOT-20 scores than nonsmokers (p = 0.01). Smokers also had higher psychological (p = 0.04), sleep (p = 0.01), and ear/facial (p = 0.001) domain scores than nonsmokers at 2 years. The long-term effects of MIER for sinus cancer showed improved psychological and sleep scores at both 1 year and 2 years. Unfortunately, rhinologic QOL did not statistically improve at any of the measured time points. History of smoking was noted to be the most important predictor of QOL 2 years after MIER for sinonasal malignancy. © 2015 ARS-AAOA, LLC.

  13. Database for the collection and analysis of clinical data and images of neoplasms of the sinonasal tract.

    PubMed

    Trimarchi, Matteo; Lund, Valerie J; Nicolai, Piero; Pini, Massimiliano; Senna, Massimo; Howard, David J

    2004-04-01

    The Neoplasms of the Sinonasal Tract software package (NSNT v 1.0) implements a complete visual database for patients with sinonasal neoplasia, facilitating standardization of data and statistical analysis. The software, which is compatible with the Macintosh and Windows platforms, provides multiuser application with a dedicated server (on Windows NT or 2000 or Macintosh OS 9 or X and a network of clients) together with web access, if required. The system hardware consists of an Apple Power Macintosh G4500 MHz computer with PCI bus, 256 Mb of RAM plus 60 Gb hard disk, or any IBM-compatible computer with a Pentium 2 processor. Image acquisition may be performed with different frame-grabber cards for analog or digital video input of different standards (PAL, SECAM, or NTSC) and levels of quality (VHS, S-VHS, Betacam, Mini DV, DV). The visual database is based on 4th Dimension by 4D Inc, and video compression is made in real-time MPEG format. Six sections have been developed: demographics, symptoms, extent of disease, radiology, treatment, and follow-up. Acquisition of data includes computed tomography and magnetic resonance imaging, histology, and endoscopy images, allowing sequential comparison. Statistical analysis integral to the program provides Kaplan-Meier survival curves. The development of a dedicated, user-friendly database for sinonasal neoplasia facilitates a multicenter network and has obvious clinical and research benefits.

  14. Rapid review: sinonasal surgery vs. medical therapy for asthma in patients with chronic rhinosinusitis with or without nasal polyps.

    PubMed

    de Bruin, Rick Johan Matthies; Hage, Rene; van der Zaag-Loonen, Hester; van Benthem, Peter Paul Germain

    2016-09-01

    The objective of the study was to compare the effect of sinonasal surgery vs. medical treatment on asthma in patients with chronic rhinosinusitis with or without nasal polyps. We executed a PRISMA guidelines-based systematic search of the following databases: PubMed, CENTRAL, Embase, Scopus and CINAHL. The search ran from database inception until 26 Feb 2014. We included controlled clinical trials comparing surgical intervention with medical intervention in patients with chronic rhinosinusitis with or without nasal polyps. We included only English papers. We used a pre-defined data collection form. Two authors independently assessed study quality. We assessed directness of evidence and risk of bias using pre-defined criteria. Our search yielded 2004 original articles, six of which satisfied our inclusion criteria. One article was excluded from further review because no comparison could be made of the subgroup of operated asthmatic patients versus the non-surgical control group. Only one study used objective pulmonary function measurements in asthmatics undergoing sinonasal surgery and therefore had the highest directness of evidence. Also it had a low risk of bias. Patient characteristics, treatments and outcome measures varied across studies, as did the observed effect. Risk of bias was high in most studies. Patient characteristics, treatment and outcome measurement differed across studies, making a comparison of the effects difficult. There is a risk of publication language bias. There is insufficient evidence either for or against sinonasal surgery for asthma control as compared to medical treatment.

  15. Extensively Myxoid and Hyalinized Sinonasal Capillary Hemangiomas: A Clinicopathologic Study of 16 Cases of a Distinctive and Potentially Confusing Hemangioma Variant.

    PubMed

    Guo, Ruifeng; Folpe, Andrew L

    2015-11-01

    Capillary hemangiomas, the most common vascular tumors of the sinonasal region, are benign endothelial neoplasms, typically growing in an easily recognized lobular pattern. Some sinonasal capillary hemangiomas may show atypical features, such as high cellularity or mitotic activity, and represent more challenging diagnoses. Over the past several years we have seen in consultation a number of examples of sinonasal capillary hemangiomas displaying very striking stromal myxoid change and hyalinization, features that have received scant attention in the past. Available slides from 16 sinonasal capillary hemangiomas previously coded as showing such changes were retrieved from our archives. Submitting diagnoses included "query angiofibroma, rule out malignancy" (N=4), "vascular polyp, rule out malignancy" (N=3), "query malignant vascular tumor" (N=4), "sinonasal hemangiopericytoma" (N=1), and "benign vascular tumor" (N=1). Available radiographic studies often showed worrisome features. Grossly, the tumors ranged from 1.1 to 6.0 cm and appeared as ulcerated, vascular-appearing polyps. Microscopically, the tumors showed striking stromal myxoid change and/or hyalinization, which largely obscured the underlying lobular capillary arrangement. Within this myxohyaline matrix, a florid capillary proliferation was present, frequently with nonatypical mitotic activity. In some instances a branching, "hemangiopericytoma-like" vascular pattern was present in areas. The overall cellularity was low to moderate, and endothelial atypia or hyperchromatism was absent. Ulceration and thrombosis were frequently present. Immunostains to CD31, CD34, and SMA highlighted areas of lobular growth pattern inapparent on the routinely stained slides. Four tested cases were negative for androgen receptors and β-catenin. Follow-up from 12 patients revealed no local recurrences or metastases. Awareness of that sinonasal capillary hemangioma may show these unusual stromal changes, and the use of

  16. Usefulness of electron microscopy in the diagnosis of "small" round cell tumors of the sinonasal region.

    PubMed

    Min, K W

    1995-01-01

    The sinonasal region is known to harbor several types of tumors that belong to the general category of "small" round cell tumors and offer considerable diagnostic challenges. This study evaluated 33 cases of such tumors by electron microscopy to characterize their ultrastructural features in conjunction with immunohistochemistry, in an attempt to define diagnostic criteria of various types. Electron microscopy was useful in the proper classification of tumors in 27 cases: esthesioneuroblastoma (EN), 12; undifferentiated carcinoma, 6; melanoma, 3; lymphoma, 3; melanotic neuroectodermal tumor, 1; rhabdomyosarcoma, 1; and pituitary adenoma, 1. In the remaining six cases, the ultrastructural features were those of poorly differentiated carcinomas. They usually exhibited some epithelial characteristics as well as neuroendocrine features by immunohistochemistry and electron microscopy. These tumors could be best described as poorly differentiated neuro-endocrine carcinomas (malignant neuroepitheliomas). The most controversial diagnostic problems existed between the tumors categorized as esthesioneuroblastomas and neuroendocrine (NE) carcinomas. Esthesioneuroblastomas were characterized by uniform round nucleated cells with variable amounts of dendritic processes containing numerous dense core granules ranging from 150 to 350 nm in the perikarya and dendritic processes. Dendritic processes contained longitudinally arranged neural tubules and revealed an occasional synaptic junction. In three of the 12 cases of EN, cells with the appearance of sustentacular cells were recognized by electron microscopy. The NE carcinomas usually consisted of closely packed round cells with scanty cytoplasm that lacked any feature of neuroblastic cells. The tumor cells in this category often were epithelioid in appearance and exhibited a varying degree of cytokeratin positivity. Neuron-specific enolase was also positive in all cases, further suggesting their neuroepithelial nature. The

  17. Sinonasal tract and nasopharyngeal adenoid cystic carcinoma: a clinicopathologic and immunophenotypic study of 86 cases.

    PubMed

    Thompson, Lester D R; Penner, Carla; Ho, Ngoc J; Foss, Robert D; Miettinen, Markku; Wieneke, Jacqueline A; Moskaluk, Christopher A; Stelow, Edward B

    2014-03-01

    Primary sinonasal tract and nasopharyngeal adenoid cystic carcinomas (STACC) are uncommon tumors that are frequently misclassified, resulting in inappropriate clinical management. Eighty-six cases of STACC included 45 females and 41 males, aged 12-91 years (mean 54.4 years). Patients presented most frequently with obstructive symptoms (n = 54), followed by epistaxis (n = 23), auditory symptoms (n = 12), nerve symptoms (n = 11), nasal discharge (n = 11), and/or visual symptoms (n = 10), present for a mean of 18.2 months. The tumors involved the nasal cavity alone (n = 25), nasopharynx alone (n = 13), maxillary sinus alone (n = 4), or a combination of the nasal cavity and paranasal sinuses (n = 44), with a mean size of 3.7 cm. Patients presented equally between low and high stage disease: stage I and II (n = 42) or stage III and IV (n = 44) disease. Histologically, the tumors were invasive (bone: n = 66; neural: n = 47; lymphovascular: n = 33), composed of a variety of growth patterns, including cribriform (n = 33), tubular (n = 16), and solid (n = 9), although frequently a combination of these patterns was seen within a single tumor. Pleomorphism was mild with an intermediate N:C ratio in cells containing hyperchromatic nuclei. Reduplicated basement membrane and glycosaminoglycan material was commonly seen. Necrosis (n = 16) and atypical mitotic figures (n = 11) were infrequently present. Pleomorphic adenoma was present in 9 cases; de-differentiation was seen in two patients. Immunohistochemical studies showed positive reactions for pan-cytokeratin, CK7, CK5/6, CAM5.2, and EMA, with myoepithelial reactivity with SMA, p63, calponin, S100 protein and SMMHC. CD117, CEA, GFAP and p16 were variably present. CK20 and HR HPV were negative. STACC needs to be considered in the differential diagnosis of most sinonasal malignancies, particularly poorly differentiated carcinoma, olfactory neuroblastoma and pleomorphic adenoma. Surgery (n = 82), often accompanied by radiation

  18. Low 22-item sinonasal outcome test scores in chronic rhinosinusitis: Why do patients seek treatment?

    PubMed

    Levy, Joshua M; Mace, Jess C; Rudmik, Luke; Soler, Zachary M; Smith, Timothy L

    2017-01-01

    Patients with chronic rhinosinusitis (CRS) who experience minimal reductions in quality of life (QoL) may present for treatment despite QoL scores comparable to controls without CRS. This study seeks to identify cofactors influencing patients with CRS and low 22-item Sinonasal Outcome Test (SNOT-22) scores to seek care. Prospective, multicenter, observational cohort. Patients with CRS were enrolled between April 2011 and September 2015. Patients with sinonasal mucocele or unilateral sinus opacification were excluded. Control subjects without CRS were enrolled for comparison. Low-SNOT CRS was defined as a SNOT-22 score < 20. A total of 774 subjects (low-SNOT CRS, n = 38; high-SNOT CRS, SNOT-22 ≥ 20, n = 641; controls without CRS, n = 95) were enrolled. Low SNOT scores were identified in 6% of subjects with CRS. After adjustment, low-SNOT CRS and control groups without CRS reported similar baseline average SNOT-22 total scores (P = .879). Unexpectedly, compared to controls, low-SNOT CRS patients had significantly better average psychological (2.1 ± 2.3 vs. 5.8 ± 6.0; P = .030) and sleep dysfunction (2.7 ± 3.4 vs. 6.0 ± 5.2; P = .016) scores. Fourteen of 38 (37%) low-SNOT patients elected to undergo endoscopic sinus surgery (ESS), with a significantly lower likelihood of reporting a minimal clinically important difference (MCID) when compared to high-SNOT patients (43% vs. 82%; P < .001) after a mean follow-up of ∼15 months. Low-SNOT CRS patients represent an outlier population for which measures of QoL fail to identify factors influencing the decision to seek treatment. Low-SNOT CRS patients electing ESS have a decreased likelihood of reporting MCIDs following ESS. Further study is required to identify novel factors associated with treatment-seeking behavior in this population. 3B Laryngoscope, 127:22-28, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  19. Biodegradable Nasal Packings for Endoscopic Sinonasal Surgery: A Systematic Review and Meta-Analysis

    PubMed Central

    Yan, Maoxiao; Zheng, Dandan; Li, Ying; Zheng, Qiaoli; Chen, Jia; Yang, Beibei

    2014-01-01

    Objectives To assess biodegradable nasal packing effectiveness for improving postoperative symptoms and mucosal healing after endoscopic sinonasal surgery as compared with conventional/non-packing groups. Methods Relevant articles were searched on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials (RCTs) that compared biodegradable packings with conventional packings or no packing, reporting postoperative symptoms and/or mucosal healing outcomes. Results This review included 19 studies, of which 11 compared biodegradable packings with conventional packings. Meta-analysis found that biodegradable packings significantly improved postoperative symptoms: bleeding at removal, pain at removal, pain in situ, and nasal blockage. Mucosal healing outcomes were inconsistent within studies, with no data could be pooled. Eight studies compared biodegradable packings with non-packing group. Postoperative symptom data in this comparison could not be pooled: A protective or equal effect on postoperative bleeding was reported in different studies; no difference was reported in pain status and nasal blockage. As for mucosal healing, meta-analysis showed that two arms of comparison had similar effect on synechiae, edema, infection and granulation at each time point. Conclusion The limiting evidence suggests that biodegradable nasal packings are statistically better than conventional packings in postoperative symptoms, and probably comparable to non-packing group, as in this comparison we could not carry out meta-analysis. No beneficial or detrimental effect on postoperative mucosal healing could be determined based on existing evidence. PMID:25526585

  20. How Reliable Are Sino-Nasal Cell Lines for Studying the Pathophysiology of Chronic Rhinosinusitis?

    PubMed Central

    Suwara, Monika I.; Borthwick, Lee A.; Wilson, Janet A.; Mann, Derek A.; Fisher, Andrew J.

    2015-01-01

    Background: Well-characterized cell lines represent useful scientific tools to study the pathophysiology of human disease. Chronic rhinosinusitis (CRS) is a very common condition, though the number of CRS cell lines is limited, as are data showing how closely they resemble primary cells. Methodology: Searches for available human cell lines were performed using the American Type Culture Collection (ATCC) and European Collection of Cell Cultures (ECACC). Identified cells were cultured and characterized with tinctorial and immunohistochemical staining and ELISA to assess their response to common, disease-relevant inflammatory stimuli. Carefully phenotyped CRS patients were recruited with informed consent. Primary nasal epithelial cell (PNEC) brushings were harvested, cultured, and compared to the available cell lines. Results: Searches identified 1 relevant CRS sino-nasal cell line, RPMI 2650. Cultured PNECs showed strong expression of epithelial markers while being negative for mesenchymal markers. However, RPMI 2650 cells show an atypical mixed epithelial/mesenchymal phenotype. When stimulated by pro-inflammatory ligands, PNECs responded in a dose-dependent manner, whereas RPMI 2650 cells showed limited response. Conclusions: The number and availability of cell lines to study the pathophysiology of CRS greatly underrepresent the disease burden. Additionally, the sole commercially available cell line appears to have a different phenotype and behavior to primary patient-derived cells. The development of further reproducible cell lines would be beneficial in our understanding of CRS. PMID:25539661

  1. Three-Layer Reconstruction with Iliotibial Tract After Endoscopic Resection of Sinonasal Tumors.

    PubMed

    Mattavelli, Davide; Schreiber, Alberto; Ferrari, Marco; Accorona, Remo; Bolzoni Villaret, Andrea; Battaglia, Paolo; Castelnuovo, Paolo; Nicolai, Piero

    2017-05-01

    Watertight reconstruction to separate the intradural compartment from the sinonasal cavities is crucial after endoscopic resection with transnasal craniectomy for nasoethmoidal tumors. A 3-layer reconstruction with the iliotibial tract is a safe and reliable alternative when vascularized flaps are unavailable. The iliotibial tract graft is harvested on the lateral aspect of the thigh and divided into 3 portions, which are positioned in a multilayered fashion to close the skull base defect: the intracranial intradural layer (first layer), the intracranial extradural layer (second layer), and the extracranial extradural layer (third layer). Fat grafts from thigh subcutaneous tissue are placed between the second and third layers to fill the dead space between them. Use of fibrin glue and intradural irrigation may help the surgeon to stabilize the layers during reconstruction. Three-layer reconstruction with the iliotibial tract is a feasible, highly reproducible, safe, and always available option for reconstruction of anterior skull base defects after endoscopic resection with transnasal craniectomy for nasoethmoidal tumors. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Low-Grade, Nonintestinal Nonsalivary Sinonasal Adenocarcinoma Associated With an Exophytic Schneiderian Papilloma: A Case Report.

    PubMed

    Blumberg, Jeffrey M; Escobar-Stein, Juliana; Vining, Eugenia M; Prasad, Manju L

    2015-12-01

    Sinonasal adenocarcinoma is a rare tumor of the head and neck accounting for 10% to 20% of all primary malignancies of the nose and paranasal sinuses. There tumors are classified as salivary, intestinal and nonintestinal, nonsalivary. Low-grade nonintestinal nonsalivary are rare tumors whose diagnosis is essentially that of exclusion. Here we present the first case of one such tumor associated with an exophyic Schneiderian papilloma. A 71-year-old retired aerospace engineer presented with a 1-year history of severe nasal obstruction. Endoscopy and compted tomography imaging demonstrated a polypoid lesion occupying his entire right nasal cavity extending into and filling the nasopharynx. Biopsy suggested adenocarcinoma, at least in situ and the patient subsequently underwent complete resection. Pathologic evaluation demonstrated polypoid tumor consistent with a low-grade papillary adenocarcinoma with micropapillary architecture associated with a small amount of residual exophytic Schneiderian papilloma. Immunohistochemistry revealed diffuse expression of CK7, CK 5/6, and S100 protein in tumor cells. Expression of p63 was seen in basal cells only. Tumor cells did not show expression of CK20, CDX2 (intestinal markers), mammaglobin, GATA3 (salivary markers), PAX8, WT1, nor estrogen, progesterone, or androgen receptors confirming its nonintestinal nonsalivary differentiation. © The Author(s) 2015.

  3. Prevalence of Human Papilloma Virus in Sinonasal Papilloma in Southern Iranian Population.

    PubMed

    Valibeigi, Behnaz; Ashraf, Mohamad Javad; Kerdegari, Narges; Safai, Akbar; Abedi, Elham; Khademi, Bijan; Azarpira, Negar

    2017-06-01

    Sinonasal papilloma (SNP) is a rare benign lesion characterized by high recurrence rate and malignant transformation. This study aimed to investigate the prevalence of human papilloma virus (HPV) infection in these lesions in South of Iran. In this cross sectional retrospective study, a total of 41 patients, 38 SNP and 3 SNP/Squamous cell carcinoma cases, from 2007 to 2014 were studied. Human papilloma virus (HPV) DNA detection was performed by nested PCR method and positive cases were analyzed for high risk HPV-16 and HPV-18. HPV was detected in 31.7%; HPV- 16 in 4.9% and HPV 18 was not detected at all. Dysplastic epithelium was detected in 53% that was not associated with HPV. Three cases were accompanied with malignant transformation that HPV genome was detected in only one case and none of them were positive for HPV16 /18 genomic DNA. Current research suggests that HPV may be involved in the development of SNP. But the high risk HPV is not important in malignant transformation. More studies are needed to elucidate the possible etiologic mechanism between HPV, inverted papilloma, and squamous cell carcinoma.

  4. Clinical management of squamous cell carcinoma associated with sinonasal inverted papilloma.

    PubMed

    Yasumatsu, Ryuji; Nakashima, Torahiko; Sato, Masanobu; Nakano, Takafumi; Kogo, Ryunosuke; Hashimoto, Kazuki; Sawatsubashi, Motohiro; Nakagawa, Takashi

    2017-02-01

    The aim of this study was to investigate the clinical features and prognosis of patients with squamous cell carcinoma (SCC) associated with sinonasal inverted papilloma (IP). The medical records of 95 patients who were diagnosed with IP or SCC associated with IP were retrospectively reviewed. Out of 95 patients, 15 were diagnosed with SCC associated with IP. The clinical characteristics, treatment modalities, and survival outcomes of the patients were analyzed. The incidence of SCC associated with IP was 15.8%. Although differential diagnosis between IP and SCC associated with IP is difficult, epistaxis may be the specific symptom in SCC associated with IP cases. The 3-year disease-specific survival rate was higher in cases with T1, 2 and 3 than in cases with T4. There was no significant difference in survival rate between maxillary sinus and other primary sites. On the other hand, there was a significant difference in survival rate between the microscopic SCC with IP cases and the other cases. In addition, the patients with <70 years old better than those with >70 years old with a 3-year disease free survival of 80% versus 0%. Some T4 patients were found to have a highly aggressive disease. Therefore, complete surgical resection followed by chemo-radiation therapy is the recommended treatment for patients with T4 disease to control of the primary tumor site. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Does human papilloma virus play a role in sinonasal inverted papilloma?

    PubMed

    Govindaraj, Satish; Wang, Hailun

    2014-02-01

    Inverted papillomas are a benign sinonasal tumor with a propensity for recurrence and malignant transformation. Although many investigations have been made into the nature of this disease, its etiology and causes for malignant transformation have yet to be fully elucidated. It is the authors' objective to present a review on management of the disease and evaluate the present relationship between human papilloma virus (HPV) and inverted papilloma. A causal relationship between HPV and the pathogenesis and progression of inverted papilloma has been posited since the 1980s. Although widely varied HPV detection rates have been reported, recent studies have noted a substantial increase in both recurrence and malignant transformation in HPV-infected inverted papillomas. However, exact cellular mechanisms by which infection leads to subsequent recurrence and development of carcinoma have yet to be elucidated. Evidence exists suggesting that HPV infection plays a role in the progression of inverted papilloma and confers an increased risk for recurrence and malignant transformation. PCR is the preferred detection method, and fresh or frozen specimens are the ideal source of tissue for evaluation. Although multiple studies have detected an association between HPV and inverted papilloma (both recurrent and malignant transformation), further studies are necessary to elucidate the underlying molecular pathways before an association can be changed to causation.

  6. Roles of human papillomavirus infection and stathmin in the pathogenesis of sinonasal inverted papilloma.

    PubMed

    Lin, Hai; Lin, Dong; Xiong, Xi-Sheng

    2016-02-01

    The purpose of this study was to investigate roles of human papillomavirus (HPV) infection and stathmin in sinonasal inverted papilloma (SNIP). HPV DNA detection was performed by the fluorescence-based polymerase chain reaction (PCR) method. Stathmin protein expression was investigated by the immunohistochemistry method and mRNA expression of stathmin, Kif2a, and cyclin D1 were assessed by real-time PCR in SNIP and control subjects. The positive rate of HPV DNA detected in SNIP was about 53.6% (15 of 28). Recurrent cases showed a higher rate of HPV infection compared with initial cases and higher Krouse stage (T3 + T4) cases showed higher rate of HPV infection than lower Krouse stage (T1 + T2) cases. Stronger expression of stathmin, Kif2a, and cyclin D1 were observed in SNIP, especially HPV(+) SNIP. HPV infection was closely associated with recurrence and progression of SNIP. Stathmin is a valuable prognostic marker and could be considered as a therapeutic target in patients with SNIP. © 2015 Wiley Periodicals, Inc.

  7. Aberrant Expression Profile of Long Noncoding RNA in Human Sinonasal Squamous Cell Carcinoma by Microarray Analysis

    PubMed Central

    Meng, Ling-zhao; Sun, Jing-wu; Yang, Fan

    2016-01-01

    Objectives. This study aimed to identify aberrantly expressed long noncoding RNAs (lncRNAs) profile of sinonasal squamous cell carcinoma (SSCC) and explore their potential functions. Methods. We investigated lncRNA and mRNA expression in SSCC and paired adjacent noncancerous tissues obtained from 6 patients with microarrays. Gene ontology (GO) analysis and pathway analysis were utilized to investigate the gene function. Gene signal-network and lncRNA-mRNA network were depicted. Quantitative real-time polymerase chain reaction (qRT-PCR) was utilized to validate 5 lncRNAs in a second set of paired SSCC and adjacent noncancerous tissues obtained from 22 additional patients. Results. We identified significantly differentially expressed lncRNAs (n = 3146) and mRNAs (n = 2208) in SSCC relative to noncancerous tissues. The GO annotation indicated that there are some core gene products that may be attributed to the progress of SSCC. The pathway analysis identified many pathways associated with cancer. The results of lncRNA-mRNA network and gene signal-network implied some core lncRNAs/mRNAs might play important roles in SSCC pathogenesis. The results of qRT-PCR showed that all of the 5 lncRNAs were differentially expressed and consistent with the microarray results. Conclusion. Our study is the first screening and analysis of lncRNAs expression profile in SSCC and may offer new insights into pathogenesis of this disease. PMID:28044124

  8. Intensity-Modulated Radiotherapy for Sinonasal Cancer: Improved Outcome Compared to Conventional Radiotherapy

    SciTech Connect

    Dirix, Piet; Vanstraelen, Bianca; Jorissen, Mark; Vander Poorten, Vincent; Nuyts, Sandra

    2010-11-15

    Purpose: To evaluate clinical outcome and toxicity of postoperative intensity-modulated radiotherapy (IMRT) for malignancies of the nasal cavity and paranasal sinuses. Methods and Materials: Between 2003 and 2008, 40 patients with cancer of the paranasal sinuses (n = 34) or nasal cavity (n = 6) received postoperative IMRT to a dose of 60 Gy (n = 21) or 66 Gy (n = 19). Treatment outcome and toxicity were retrospectively compared with that of a previous patient group (n = 41) who were also postoperatively treated to the same doses but with three-dimensional conformal radiotherapy without intensity modulation, from 1992 to 2002. Results: Median follow-up was 30 months (range, 4-74 months). Two-year local control, overall survival, and disease-free survival were 76%, 89%, and 72%, respectively. Compared to the three-dimensional conformal radiotherapy treatment, IMRT resulted in significantly improved disease-free survival (60% vs. 72%; p = 0.02). No grade 3 or 4 toxicity was reported in the IMRT group, either acute or chronic. The use of IMRT significantly reduced the incidence of acute as well as late side effects, especially regarding skin toxicity, mucositis, xerostomia, and dry-eye syndrome. Conclusions: Postoperative IMRT for sinonasal cancer significantly improves disease-free survival and reduces acute as well as late toxicity. Consequently, IMRT should be considered the standard treatment modality for malignancies of the nasal cavity and paranasal sinuses.

  9. Characteristic findings of malignant melanoma in the sinonasal cavity on magnetic resonance imaging.

    PubMed

    Xu, Qing-Gang; Fu, Li-Ping; Wang, Zhen-Chang; Xian, Jun-Fang; He, Li-Yan; Zhang, Zheng-Yu; Liu, Cheng-Yao

    2012-10-01

    Malignant sinonasal melanoma (MSM) is a rare tumor with a perplexing signal intensity due to variable histopathologic components. This study was undertaken to delineate its MR imaging features. MR imaging findings of 10 patients (6 women and 4 men, mean age 61.3 years old) with pathologically confirmed MSM were retrospectively reviewed. The location, size, signal intensity, enhancement, and internal imaging characteristics of all tumors were evaluated. Signal intensity and degree of enhancement was graded in comparison with the gray matter and adjacent muscle uptake, respectively. There were 8 tumors that were pathologically confirmed to contain melanin. Compared to gray matter of the brain, 7 of them demonstrated hyperintensity on T1WI and 6 (6/7) showed hypointensity on T2WI. There was multiple linear, dark-signal intensity on T2WI within the mass in 9 of the 10 patients' tumors. Evaluated with gadolinium-enhanced imaging, all 10 patients showed moderate enhancement within the areas that were isointense in the lesion on pregadolinium T1WI. Moreover, some parts which displayed hyperintensity on T1WI within the tumors of 7 patients showed mild enhancement that was similar to muscle on a time-intensity curve (TIC). MSM shows characteristic MR signal intensity (hyperintensity on T1WI and the linear, low-signal intensity on T2WI), which may provide valuable information for clinical diagnosis. Together with conventional MRI, TIC may be useful for indicating pleomorphic patterns of MSM.

  10. What causes canine sino-nasal aspergillosis? A molecular approach to species identification.

    PubMed

    Talbot, Jessica J; Johnson, Lynelle R; Martin, Patricia; Beatty, Julia A; Sutton, Deanna A; Billen, Frédéric; Halliday, Catriona L; Gibson, Justine S; Kidd, Sarah; Steiner, Jörg M; Ujvari, Beata; Barrs, Vanessa R

    2014-04-01

    On the basis of phenotypic identification methods, Aspergillus fumigatus is reported as the most commonly identified aetiological agent of canine sino-nasal aspergillosis (SNA). However, definitive identification of Aspergillus spp. using phenotypic features alone is unreliable. The aim of this study was to determine the molecular identities of fungal species causing SNA in dogs. Genomic DNA was extracted from 91 fungal isolates from 90 dogs diagnosed with SNA in Australia, the USA and Belgium, and the ITS1-5.8S-ITS2 ribosomal DNA and partial β-tubulin regions were sequenced. Eighty-eight of 91 (96.7%) isolates were identified as A. fumigatus and 3/91 (3.3%) belonged to Aspergillus section Nigri spp. (Aspergillus tubingensis: 2/91; Aspergillus uvarum: 1/91). These findings confirm that A. fumigatus is the most common aetiological agent of canine SNA. This is the first report to document a pathogenic role for A. tubingensis and A. uvarum in dogs. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  11. Sinonasal Cancer and Occupational Exposure in a Population-Based Registry

    PubMed Central

    Mensi, Carolina; Sieno, Claudia; Riboldi, Luciano; Bertazzi, Pier Alberto

    2013-01-01

    We examined occupational exposures among subjects with sinonasal cancer (SNC) recorded in a population-based registry in the Lombardy Region, the most populated and industrialized Italian region. The registry collects complete clinical information and exposure to carcinogens regarding all SNC cases occurring in the population of the region. In the period 2008–2011, we recorded 210 SNC cases (137 men, 73 women). The most frequent occupational exposures were to wood (44 cases, 21.0%) and leather dust (29 cases, 13.8%), especially among men: 39 cases (28.5%) to wood and 23 cases (16.8%) to leather dust. Exposure to other agents was infrequent (<2%). Among 62 subjects with adenocarcinoma, 50% had been exposed to wood dust and 30.7% to leather dust. The proportions were around 10% in subjects with squamous cell carcinoma and about 20% for tumors with another histology. The age-standardized rates (×100,000 person-years) were 0.7 in men and 0.3 in women. Complete collection of cases and their occupational history through a specialized cancer registry is fundamental to accurately monitor SNC occurrence in a population and to uncover exposure to carcinogens in different industrial sectors, even those not considered as posing a high risk of SNC, and also in extraoccupational settings. PMID:24082884

  12. Endoscopic endonasal surgery for resection of benign sinonasal tumors: experience with 105 patients.

    PubMed

    Baradaranfar, Mohammad-Hossein; Dabirmoghaddam, Payman

    2006-07-01

    The use of endoscopic surgery for nasal and sinus pathologies has revolutionized our approaches towards the diseases of these areas. To report our experience with endoscopic surgery of benign tumors and tumor-like conditions of the nose and paranasal sinuses. The medical records of 105 patients with benign sinonasal tumor, who had undergone endoscopic surgery for removal of their neoplasm between 1997 and 2003, were retrospectively studied. The studied patients included 32 with juvenile nasopharyngeal angiofibroma, 24 with inverted papilloma, 23 with benign fibroosseous lesions, 18 with pyogenic granuloma, 6 with intranasal hemangioma, and 2 with pleomorphic adenoma. The patients had a follow-up ranging from 9 to 73 (mean: 41) months. During the follow-up period, the patients were under close observation by performing serial endoscopy and yearly CT scan. Eight cases of recurrent tumor--2 angiofibroma, 4 inverted papilloma, 1 fibrous dysplasia, and 1 osteoma--were noted and managed endoscopically alone or in combination with Caldwell-Luc approach. The major complication encountered in this study was cerebrospinal fluid leakage (2 cases) that was sealed intra-operatively with local tissue flaps without any further sequela. Endoscopic surgery is a valuable tool for removal of benign tumors of the nose and paranasal sinuses in the hands of an experienced surgeon.

  13. Incidence and Survival Patterns of Sinonasal Undifferentiated Carcinoma in the United States

    PubMed Central

    Chambers, Kyle J.; Lehmann, Ashton E.; Remenschneider, Aaron; Dedmon, Matthew; Meier, Josh; Gray, Stacey T.; Lin, Derrick T.

    2014-01-01

    Objective To determine trends in sinonasal undifferentiated carcinoma (SNUC) survival patterns in the United States. Design Retrospective review of national database. Participants All cases of SNUC in the National Cancer Institute's Surveillance Epidemiology and End Results program from 1973 to 2010 were examined. Main Outcome Measures Age-adjusted incidence and survival rates were calculated and stratified by demographic information and treatment modality. Cohort analysis was performed to analyze survival patterns over time. Results A total of 318 SNUC cases were identified. Age-adjusted incidence rate (IR) was 0.02 per 100,000. Incidence was greater in males (IR: 0.03) than females (IR: 0.01; p = 0.03). Overall 5- and 10-year relative survival rate was 34.9% and 31.3%, respectively. Overall median survival was 22.1 months. Median survival following surgery combined with radiation was 41.9 months. Five-year relative survival rate following surgery, radiation, or surgery combined with radiation was 38.7%, 36.0%, and 39.1%, respectively. Median survival from 1973–1986 and 1987–2010 was 14.5 and 23.5 months, respectively. Conclusions This study provides new data regarding survival patterns of SNUC in the United States, confirming survival benefit with surgery and radiation as well as identifying a trend toward improved survival in recent decades. PMID:25844294

  14. TERT promoter mutations in sinonasal malignant melanoma: a study of 49 cases.

    PubMed

    Jangard, Mattias; Zebary, Abdlsattar; Ragnarsson-Olding, Boel; Hansson, Johan

    2015-06-01

    Sinonasal malignant melanoma (SNMM) comprises less than 1% of all melanomas and is located in the nasal cavity and the paranasal sinuses. The majority of SNMMs have unknown underlying oncogenic driver mutations. The recent identification of a high frequency of driver mutations in the promoter of the telomerase reverse transcriptase (TERT) gene in cutaneous melanoma led us to investigate whether these mutations also occur in SNMM. Our aim was to determine the TERT promoter mutation frequencies in primary SNMMs. Laser capture microdissection and manual dissection were used to isolate tumour cells from 49 formalin-fixed paraffin-embedded tissues. The tumours were screened for TERT promoter mutations by direct Sanger sequencing. Information on NRAS, BRAF and KIT mutation was available from an earlier study. Overall, 8% (4/49) of SNMMs harboured TERT promoter mutations. One of these mutated tumours had a coexistent NRAS mutation and one had a BRAF mutation. Our findings show that TERT promoter mutations are present in a moderate proportion of SNMM. No conclusion can be drawn on their potential influence on the clinical outcome or tumour progression.

  15. Recurrent DNA copy number alterations in intestinal-type sinonasal adenocarcinoma.

    PubMed

    Perez-Escuredo, J; Lopez-Hernandez, A; Costales, M; Lopez, F; Ares, S P; Vivanco, B; Llorente, J L; Hermsen, M A

    2016-09-01

    Intestinal-type sinonasal adenocarcinoma (ITAC) is a rare tumour related to occupational wood dust exposure. Few studies have described recurrent genetic changes on a genome-wide scale. The aim of this study was to obtain a high resolution map of recurrent genetic alterations in ITAC. Copy number alterations were evaluated by microarray CGH and MLPA in 37 primary tumours. The results were correlated with pathological characteristics and clinical outcome. Microarray CGH identified the following recurrent aberrations, in descending order: gains at 5p15 (22 cases, 60%), 8q24 (21 cases, 57%), 20q13 (20 cases, 54%), 20q11, and 8q21 (19 cases, 51%), 20p13, and 7p11 (16 cases, 43%), and losses at 5q11-qter, 8p12-pter, and 18q12-23 (15 cases, 40%), and 17p13, and 19p13 (13 cases, 35%). MLPA analysis confirmed this global pattern of gains and losses. Chromosomal loss at 4q32-ter and gains at 1q22, 6p22 and 3q29, as well as deletion of TIMP2 and CRK correlated with unfavourable clinical outcome. ITACs have a unique pattern of chromosomal abnormalities. The four different histological subtypes of ITAC appeared genetically similar. Four chromosomal gains and losses and two specific genes showed prognostic value and may be involved in tumour progression.

  16. Readout-segmented echo-planar imaging in the evaluation of sinonasal lesions: A comprehensive comparison of image quality in single-shot echo-planar imaging.

    PubMed

    Zhao, Menglong; Liu, Zhuang; Sha, Yan; Wang, Shenjiang; Ye, Xinpei; Pan, Yucheng; Wang, Shaoyu

    2016-02-01

    To investigate the role of readout-segmented echo-planar imaging using parallel imaging and a two-dimensional (2D) navigator (RESOLVE) in the evaluation of sinonasal lesions and to qualitatively and quantitatively compare the image qualities of single-shot echo-planar imaging (SS-EPI) and RESOLVE. Both sinonasal SS-EPI and RESOLVE images were acquired from 32 patients on a 3-T MR scanner. Image quality, lesion conspicuity and the distortions of the SS-EPI and RESOLVE images were qualitatively evaluated by two radiologists. Distortion was also quantitatively evaluated by comparing the distances between the same anatomic points on TSE-T1WI, TSE-T2WI, SS-EPI and RESOLVE images. The apparent diffusion coefficient (ADC) values, signal-to-noise ratios (SNRs), and contrast-to-noise ratios (CNRs) of the two DWIs were compared. The comparisons of the qualitative scores indicated that RESOLVE significantly improved the image quality and lesion conspicuity and reduced the distortion of the sinonasal diseases. The orbit, skull base, temporal bone and upper neck were also better displayed on RESOLVE. Quantitative evaluations revealed that RESOLVE greatly reduced but did not completely remove the distortion. The ADC values of the sinonasal lesions on RESOLVE were lower than those on SS-EPI, whereas no differences were found in the brainstem. The SNR of RESOLVE was lower than that of SS-EPI. There were no differences in the CNRs of the two diffusion-weighted imaging (DWI) techniques. RESOLVE significantly improved the image quality for evaluations of sinonasal lesions by reducing the susceptibility artifacts, distortion and blurring compared with SS-EPI. RESOVLE offers more accurate ADC values of sinonasal lesions than SS-EPI. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Chitin stimulates expression of acidic mammalian chitinase and eotaxin-3 by human sinonasal epithelial cells in vitro

    PubMed Central

    Lalaker, Ashley; Nkrumah, Louis; Lee, Won-Kyung; Ramanathan, Murugappan; Lane, Andrew P.

    2010-01-01

    Background Sinonasal epithelial cells participate in host defense by initiating innate immune mechanisms against potential pathogens. Antimicrobial innate mechanisms have been shown to involve Th1-like inflammatory responses. Although epithelial cells can also be induced by Th2 cytokines to express proeosinophilic mediators, no environmental agents have been identified that promote this effect. Methods Human sinonasal epithelial cells from patients with chronic rhinosinusitis with nasal polyps (CRSwNPs) and controls were harvested and grown in primary culture. Cell cultures were exposed to a range of concentrations of chitin for 24 hours, and mRNA for acidic mammalian chitinase (AMCase), eotaxin-3, and thymic stromal-derived lymphopoietin (TSLP) were assessed. Other cultures were exposed to interleukin 4 (IL- 4) alone and in combination with dust-mite antigen (DMA) for 36 hours. Extracted mRNA and cell culture supernatant were analyzed for expression of AMCase and eotaxin-3. Results Chitin induced a dose-dependent expression of AMCase and eotaxin-3 mRNA but not TSLP. Patients with recalcitrant CRSwNPs showed lower baseline expression of AMCase when compared with treatment-responsive CRSwNP and less induction of AMCase expression by chitin. DMA did not directly induce expression of AMCase or eotaxin-3. Expression of eotaxin-3 was stimulated by IL-4 and further enhanced with the addition of DMA. Levels of AMCase were not significantly affected by either IL-4 or DMA exposure. In some cases, the combination of IL-4 and DMA was able to induce AMCase expression in cell cultures not producing AMCase at baseline. Conclusion The abundant biopolymer chitin appears to be recognized by a yet uncharacterized receptor on sinonasal epithelial cells. Chitin stimulates production of AMCase and eotaxin-3, two pro-Th2 effector proteins. This finding suggests the existence of a novel innate immune pathway for local defense against chitin-containing organisms in the sinonasal tract

  18. Smoking, not human papilloma virus infection, is a risk factor for recurrence of sinonasal inverted papilloma.

    PubMed

    Roh, Hwan-Jung; Mun, Sue Jean; Cho, Kyu-Sup; Hong, Sung-Lyong

    2016-01-01

    The recurrence rate of sinonasal inverted papillomas (SNIP) is 15-20%. However, few studies have investigated patient-dependent factors related to recurrence of SNIPs. To analyze risk factors, including human papilloma virus (HPV) infection and smoking, as well as other factors, for recurrence of SNIPs. Fifty-four patients who were diagnosed with SNIP and underwent surgery were enrolled: 39 men and 15 women, with the mean age of 54.0 years. Their mean follow-up was 40.6 months. Demographics and information about the history of smoking, previous surgery, tumor extent, follow-up, and recurrence were reviewed retrospectively. Those patients whose tumors were associated with malignant transformation were excluded in this study. HPV detection and genotyping in the tumor specimens were performed with the HPV DNA chip, a polymerase chain reaction-based DNA microarray system. Seven patients (13.0%) had recurrence, with a mean time to recurrence of 39.8 months. Recurrence rates in T1, T2, T3, and T4 of the Krouse staging system were 0% (0/4), 8.3% (2/24), 17.4% (4/23), and 33.3% (1/3), respectively (p > 0.5). Eight patients (14.8%) were positive for HPV DNA. All of these patients belonged to the group without recurrence (p > 0.5). However, recurrence rates according to HPV DNA positivity were not statistically different (0% versus 15.2%). Three (42.9%) in the group with recurrence and four (8.5%) in the group without recurrence were smokers (p < 0.5). Smoking was associated with recurrence of SNIP. However, HPV infection is not a recurrence of SNIP risk factor.

  19. Sinonasal extramedullary plasmacytoma: a population-based incidence and survival analysis.

    PubMed

    Patel, Tapan D; Vázquez, Alejandro; Choudhary, Moaz M; Kam, David; Baredes, Soly; Eloy, Jean Anderson

    2015-09-01

    Sinonasal extramedullary plasmacytoma (SN-EMP) is a rare plasma cell neoplasm. Published literature on this tumor largely consists of case reports and case-series with small sample sizes. This study analyzed population-based data on SN-EMP patients to understand demographic and clinical features as well as incidence and survival trends. The Surveillance, Epidemiology, and End Results (SEER) database was queried for SN-EMP and other head and neck EMP (HN-EMP) cases from 1973 to 2011. Cases were analyzed to determine patient demographics, initial treatment modality, and survival outcomes. Of 778 patients identified with EMP in the head and neck region, 367 patients had SN-EMP and 411 had other HN-EMP. There was a strong male predilection found, with a male-to-female ratio of 3.65:1 in the SN-EMP group and 1.87:1 in the other HN-EMP group. The majority of the patients presented with localized disease in both SN-EMP (84.4%) and other HN-EMP (81.0%) groups. The most common treatment modality reported in this database was surgery with adjuvant radiotherapy in both SN-EMP (46.3%) and other HN-EMP (38.9%) groups, followed by radiotherapy alone (SN-EMP: 40.7%; other HN-EMP: 34.2%). Five-year and 10-year disease-specific survival rates were comparable between SN-EMP (88.2% and 83.3%, respectively) and other HN-EMP (90.0% and 87.4%, respectively) (p = 0.6016 and p = 0.4015, respectively). This study analyzed the largest cohort of SN-EMP patients to date. There was no statistically significant survival advantage found for any 1 particular treatment modality over other treatment modalities in both SN-EMP and other HN-EMP. © 2015 ARS-AAOA, LLC.

  20. Impact of tumour volume on prediction of progression-free survival in sinonasal cancer

    PubMed Central

    Hennersdorf, Florian; Mauz, Paul-Stefan; Adam, Patrick; Welz, Stefan; Sievert, Anne; Ernemann, Ulrike; Bisdas, Sotirios

    2015-01-01

    Background The present study aimed to analyse potential prognostic factors, with emphasis on tumour volume, in determining progression free survival (PFS) for malignancies of the nasal cavity and the paranasal sinuses. Patients and methods Retrospective analysis of 106 patients with primary sinonasal malignancies treated and followed-up between March 2006 and October 2012. Possible predictive parameters for PFS were entered into univariate and multivariate Cox regression analysis. Kaplan-Meier curve analysis included age, sex, baseline tumour volume (based on MR imaging), histology type, TNM stage and prognostic groups according to the American Joint Committee on Cancer (AJCC) classification. Receiver operating characteristic (ROC) curve analysis concerning the predictive value of tumour volume for recurrence was also conducted. Results The main histological subgroup consisted of epithelial tumours (77%). The majority of the patients (68%) showed advanced tumour burden (AJCC stage III–IV). Lymph node involvement was present in 18 cases. The mean tumour volume was 26.6 ± 21.2 cm3. The median PFS for all patients was 24.9 months (range: 2.5–84.5 months). The ROC curve analysis for the tumour volume showed 58.1% sensitivity and 75.4% specificity for predicting recurrence. Tumour volume, AJCC staging, T- and N- stage were significant predictors in the univariate analysis. Positive lymph node status and tumour volume remained significant and independent predictors in the multivariate analysis. Conclusions Radiological tumour volume proofed to be a statistically reliable predictor of PFS. In the multivariate analysis, T-, N- and overall AJCC staging did not show significant prognostic value. PMID:26401135

  1. Sinonasal symptom-related sleep disorders before and after surgery for nasal polyposis.

    PubMed

    Nguyen, D T; Arous, F; Gallet, P; Felix-Ravelo, M; Nguyen-Thi, P L; Rumeau, C; Jankowski, R

    2017-09-01

    Patients with nasal polyposis (NP) complain of several sinonasal symptoms that impact their sleep and quality of life. However, data on sleep disorders related to NP symptoms, before and after surgery, is poor. The aim of the present study was to analyze sleep complaints related to each NP symptom, before and after surgery, using the Dynachron questionnaire. 63 patients operated for NP were included in this prospective study. They filled the DyNaChron questionnaire one day before surgery (V0), 6 weeks (V1) and 7 months (V2) after surgery. The self-ratings (0-10 point visual analog scale) of nasal obstruction, anterior rhinorrhea, postnasal discharge, cough and 5 items related to sleep disturbances, due to each symptom of chronic nasal dysfunction, were extracted from the questionnaire and analyzed. There was significant improvement of symptoms and symptom-related sleep disturbance scores at V1 and V2 compared to baseline scores. Before surgery, moderate/severe sleep disorders that patients attributed to nasal obstruction (the patient thinks it is due to nasal obstruction rather than a clinical test to show nasal obstruction) or anterior rhinorrhea were reported in two thirds of patients, postnasal discharge in one half, and chronic cough in one third. After surgery, less than 10% of patients reported moderate/severe sleep disorders at V1. There was a mild increase of patients who rated moderate/severe sleep disorders at V2 in comparison to V1. The correlation between scores of nasal obstruction and its impacts on sleep quality was weak before surgery and strong afterwards. Nasalization improved sleep quality significantly at 6 weeks and at 7 months after surgery. However, there was a mild increase of complaints related to postnasal discharge and cough at 7 months after surgery.

  2. In vitro studies of a distillate of rectified essential oils on sinonasal components of mucociliary clearance.

    PubMed

    Lai, Yinyan; Dilidaer, D; Chen, Bei; Xu, Geng; Shi, Jianbo; Lee, Robert J; Cohen, Noam A

    2014-01-01

    Herbal remedies predate written history and continue to be used frequently for many common ailments. The essential oil mixture standardized is a phytopharmaceutical with a distillate of a mixture of rectified essential oils of eucalyptus, sweet orange, myrtle, and lemon as active ingredients used to treat respiratory diseases such as bronchitis and rhinosinusitis. We evaluated the pharmacologic effects of a distillate of rectified essential oils standardized on primary human upper respiratory epithelial cultures specifically addressing electrolyte transport, cilia beat frequency (CBF), airway surface liquid (ASL) hydration, and mucus transport velocity. Well-differentiated primary human sinonasal epithelial cultures grown at an air-liquid interface were treated on the apical or basolateral surface with varying concentrations of a distillate of rectified essential oils standardized. Changes in CBF were determined using the Sissons-Ammons Video Analysis system while changes in chloride flux were determined using the fluorescent dye 6-methoxy-N-(3-sulfopropyl)quinolinium. ASL hydration was quantified using Texas red dextran and mucociliary transport velocity was measured using fluorescent microspheres and time lapse photography. When applied to the basolateral surface, a distillate of rectified essential oils standardized activated chloride efflux and ciliary beat in a dose-dependent fashion, increasing ASL height and accelerating mucociliary transport velocity. The ancillary apical application of a distillate of rectified essential oils standardized had minimal effects on the CBF. Basolateral application of a distillate of rectified essential oils standardized stimulates both chloride efflux and cilia beat frequency resulting in a synergistic effect dramatically augmenting mucociliary transport velocity. These in vitro data support the clinical efficacy of this phytopharmaceutical in respiratory inflammatory disorders.

  3. Sinonasal papillomas in a private referral otorhinolaryngology centre: Review of 22 years experience.

    PubMed

    de Sousa Fontes, Aderito; Sandrea Jiménez, Minaret; Urdaneta Lafée, Nelson; Abreu Durán, Perfecto A; Quintana Páez, Liwven E; de Sousa de Abreu, Andreina Carmina

    To evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela). We reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed. Sixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9-80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up. Complete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  4. Flattening Filter-Free Beams in Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy for Sinonasal Cancer.

    PubMed

    Lu, Jia-Yang; Zheng, Jing; Zhang, Wu-Zhe; Huang, Bao-Tian

    2016-01-01

    To evaluate the dosimetric impacts of flattening filter-free (FFF) beams in intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for sinonasal cancer. For fourteen cases, IMRT and VMAT planning was performed using 6-MV photon beams with both conventional flattened and FFF modes. The four types of plans were compared in terms of target dose homogeneity and conformity, organ-at-risk (OAR) sparing, number of monitor units (MUs) per fraction, treatment time and pure beam-on time. FFF beams led to comparable target dose homogeneity, conformity, increased number of MUs and lower doses to the spinal cord, brainstem and normal tissue, compared with flattened beams in both IMRT and VMAT. FFF beams in IMRT resulted in improvements by up to 5.4% for sparing of the contralateral optic structures, with shortened treatment time by 9.5%. However, FFF beams provided comparable overall OAR sparing and treatment time in VMAT. With FFF mode, VMAT yielded inferior homogeneity and superior conformity compared with IMRT, with comparable overall OAR sparing and significantly shorter treatment time. Using FFF beams in IMRT and VMAT is feasible for the treatment of sinonasal cancer. Our results suggest that the delivery mode of FFF beams may play an encouraging role with better sparing of contralateral optic OARs and treatment efficiency in IMRT, but yield comparable results in VMAT.

  5. Imaging and Outcomes for a New Entity: Low-Grade Sinonasal Sarcoma with Neural and Myogenic Features

    PubMed Central

    Cannon, Richard B.; Wiggins, Richard H.; Witt, Benjamin L.; Dundar, Yusuf; Johnston, Tawni M.; Hunt, Jason P.

    2017-01-01

    Objectives Low-grade sinonasal sarcoma with neural and myogenic features (LGSSNMF) is a new, rare tumor. Our goal is to describe the imaging characteristics and surgical outcomes of this unique skull base malignancy. Design Retrospective case series. Setting Academic medical center. Participants There were three patients who met inclusion criteria with a confirmed LGSSNMF. Main Outcome Measures Imaging and histopathological characteristics, treatments, survival and recurrence outcomes, complications, morbidity, and mortality. Results Patients presented with diplopia, facial discomfort, a supraorbital mass, and nasal obstruction. Magnetic resonance imaging and computed tomography imaging in all cases showed an enhancing sinonasal mass with associated hyperostotic bone formation that involved the frontal sinus, invaded the lamina papyracea and anterior skull base, and had intracranial extension. One patient underwent a purely endoscopic surgical resection and the second underwent a craniofacial resection, while the last is pending treatment. All patients recovered well, without morbidity or long-term complications, and are currently without evidence of disease (mean follow-up of 2.1 years). One patient recurred after 17 months and underwent a repeat endoscopic skull base and dural resection. Conclusions The surgical outcomes and imaging of this unique, locally aggressive skull base tumor are characterized. PMID:28229035

  6. Flattening Filter-Free Beams in Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy for Sinonasal Cancer

    PubMed Central

    Huang, Bao-Tian

    2016-01-01

    Purpose To evaluate the dosimetric impacts of flattening filter-free (FFF) beams in intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for sinonasal cancer. Methods For fourteen cases, IMRT and VMAT planning was performed using 6-MV photon beams with both conventional flattened and FFF modes. The four types of plans were compared in terms of target dose homogeneity and conformity, organ-at-risk (OAR) sparing, number of monitor units (MUs) per fraction, treatment time and pure beam-on time. Results FFF beams led to comparable target dose homogeneity, conformity, increased number of MUs and lower doses to the spinal cord, brainstem and normal tissue, compared with flattened beams in both IMRT and VMAT. FFF beams in IMRT resulted in improvements by up to 5.4% for sparing of the contralateral optic structures, with shortened treatment time by 9.5%. However, FFF beams provided comparable overall OAR sparing and treatment time in VMAT. With FFF mode, VMAT yielded inferior homogeneity and superior conformity compared with IMRT, with comparable overall OAR sparing and significantly shorter treatment time. Conclusions Using FFF beams in IMRT and VMAT is feasible for the treatment of sinonasal cancer. Our results suggest that the delivery mode of FFF beams may play an encouraging role with better sparing of contralateral optic OARs and treatment efficiency in IMRT, but yield comparable results in VMAT. PMID:26734731

  7. Prospective comparison of sinonasal outcomes after microscopic sublabial or endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenomas.

    PubMed

    Pledger, Carrie L; Elzoghby, Mohamed A; Oldfield, Edward H; Payne, Spencer C; Jane, John A

    2016-08-01

    OBJECT Both endoscopic and microscopic transsphenoidal approaches are accepted techniques for the resection of pituitary adenomas. Although studies have explored patient outcomes for each technique individually, none have prospectively compared sinonasal and quality of life outcomes in a concurrent series of patients at the same institution, as has been done in the present study. METHODS Patients with nonfunctioning adenomas undergoing transsphenoidal surgery were assessed for sinonasal function, quality of life, and pain using the Sino-Nasal Outcome Test-20 (SNOT-20), the short form of the Nasal Obstruction Symptom Evaluation (NOSE) instrument, the SF-36, and a headache scale. Eighty-two patients undergoing either endoscopic (47 patients) or microscopic (35 patients) surgery were surveyed preoperatively and at 24-48 hours, 2 weeks, 4 weeks, 8 weeks, and 1 year after surgery. RESULTS Patients who underwent endoscopic and microscopic transsphenoidal surgery experienced a similar recovery pattern, showing an initial increase in symptoms during the first 2 weeks, followed by a return to baseline by 4 weeks and improvement beyond baseline functioning by 8 weeks. Patients who underwent endoscopic surgery experienced better sinonasal outcomes at 24-48 hours (SNOT total p = 0.015, SNOT rhinologic subscale [ssRhino] p < 0.001), 2 weeks (NOSE p = 0.013), and 8 weeks (SNOT total p = 0.032 and SNOT ssRhino p = 0.035). By 1 year after surgery, no significant differences in sinonasal outcomes were observed between the 2 groups. Headache scales at 1 year improved in all dimensions except duration for both groups (total result 73%, p = 0.004; severity 46%, p < 0.001; frequency 53%, p < 0.001), with 80% of either microscopic or endoscopic patients experiencing improvement or resolution of headache symptoms. Endoscopic and microscopic patients experienced reduced vitality preoperatively compared with US population norms and remained low postoperatively. By 8 weeks after surgery

  8. Inability of PET/CT to identify a primary sinonasal inverted papilloma with squamous cell carcinoma in a patient with a submandibular lymph node metastasis: A case report

    PubMed Central

    ZHANG, SI-CONG; WEI, LIN; ZHOU, SHUI-HONG; ZHAO, KUI

    2015-01-01

    The present study describes the first reported case of a sinonasal inverted papilloma (IP) with squamous cell carcinoma (SCC) that presented as a cancer of unknown primary in the English-language literature. In July 2010, a 66-year old male presented with a 6-month history of a painless, progressive mass in the right submandibular region. Physical examination revealed a 3×4-cm smooth, non-tender mass and subsequently, excision of the right submandibular gland was performed. Post-operative pathological examination indicated poorly-differentiated SCC of the submandibular lymph node. Positron-emission tomography/computed tomography (PET/CT) was unable to identify the primary tumour site in this case, and 14 months later the patient presented with nasal obstruction, leading to the diagnosis of right sinonasal IP with coexistent SCC. The patient received pre-operative radiotherapy, a right total maxillectomy and post-operative radiotherapy. However, the patient succumbed to a distant metastasis 37 months after the initial presentation. 18F-fluorodeoxyglucose uptake on PET/CT may be not a reliable predictor of malignancy in sinonasal IPs. Therefore, we suggest emphasis of the use of multiple biopsies for suspected sinonasal IPs in order to improve diagnostic accuracy. PMID:26622564

  9. Reduced sinonasal levels of 1α-hydroxylase are associated with worse quality of life in chronic rhinosinusitis with nasal polyps.

    PubMed

    Schlosser, Rodney J; Carroll, William W; Soler, Zachary M; Pasquini, Whitney N; Mulligan, Jennifer K

    2016-01-01

    Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have deficiencies in circulating and sinonasal levels of the inactive form of vitamin D3, 25-hydroxycholecalciferol (25VD3). Moreover, CRSwNP patients have reduced epithelial cell-specific expression of 1α-hydroxylase; the enzyme responsible for the conversion of 25VD3 to its metabolically active form, 1α,25-dihydroxyvitamin D3 (1,25VD3). The objective of this work was to determine the impact of sinonasal 1α-hydroxylase levels combined from all cellular sources on subjective disease severity and to identify variables influencing its expression. Blood and sinus tissue explants were collected at the time of surgery from control, chronic rhinosinusitis without nasal polyps (CRSsNP), CRSwNP, and allergic fungal rhinosinusitis (AFRS) patients. 1α-Hydroxylase was measured by immunostaining with flow cytometric analysis. Subjective disease severity was measured by the 22-item Sino-Nasal Outcomes Test (SNOT-22). 1,25VD3 and 25VD3 were measured by enzyme-linked immunosorbent assay (ELISA). Patients with CRSwNP or AFRS have reduced 1α-hydroxylase and 1,25VD3 compared to controls or CRSsNP. Circulating 1,25VD3 levels were the same among all groups. No differences in sinonasal 1α-hydroxylase or 1,25VD3 were found between CRSwNP and AFRS. Gender, age, race, atopy, and systemic 25VD3 had no impact on sinonasal 1α-hydroxylase levels in any group. However, CRSwNP patients with asthma had higher 1α-hydroxylase than those without asthma. Total 1α-hydroxylase levels inversely correlated with SNOT-22 in CRSwNP, but not CRSsNP. Patients with CRSwNP and AFRS both have reduced sinonasal 1α-hydroxylase and 1,25VD3 compared to controls or CRSsNP. Reductions in intracellular 1α-hydroxylase combined from all sinonasal cell types were associated with more severe subjective disease severity in CRSwNP. © 2015 ARS-AAOA, LLC.

  10. Nasal fluid release of eotaxin-3 and eotaxin-2 in persistent sinonasal eosinophilic inflammation.

    PubMed

    De Corso, Eugenio; Baroni, Silvia; Battista, Mariapina; Romanello, Matteo; Penitente, Romina; Di Nardo, Walter; Passali, Giulio Cesare; Sergi, Bruno; Fetoni, Anna Rita; Bussu, Francesco; Zuppi, Cecilia; Paludetti, Gaetano

    2014-08-01

    The aim of the present study was to measure eotaxin-3 (CCL26) and eotaxin-2 (CCL24) in nasal lavage fluid of patients with different forms of chronic sinonasal eosinophilic inflammation to evaluate their role in the pathophysiology of nasal hypereosinophilia. The study was an analytic cross-section study, level of evidence 3b. Patients (n = 80) with nasal hypereosinophilia were randomly recruited and grouped in the following categories: persistent allergic rhinitis (AR) (n = 25), nonallergic rhinitis with eosinophilia syndrome (NARES) (n = 30), and chronic rhinosinusitis with polyps (CRSwNP) (n = 25). Non-rhinitic volunteers (n = 20) were recruited as controls. CCL24 and CCL26 concentrations were measured by enzyme-linked immunosorbent assay (ELISA) Quantikine Human Immunoassays (R&D Systems, Minneapolis, MN) in nasal lavage fluids. Differential cell counts were performed by microscopic cytological examination of nasal tissue scraped from the inferior turbinate. Mean CCL26 levels were significantly higher (p < 0.05) in AR and in NARES (132.0 pg/mL and 187.63 pg/mL, respectively) than in the control group (13.5 pg/mL); in patients with CRSwNP, CCL26 values were increased compared to controls even though the difference was not statistically significant (58.9 pg/mL vs 16.5 pg/mL). Mean CCL24 levels measured in AR, NARES, and CRSwNP were significantly increased (p < 0.05) compared to controls (96.7 pg/mL, 135.4 pg/mL, and 107.0 pg/mL, respectively, vs 32.2 pg/mL). Moreover, we observed a significant correlation between CCL24 and CCL26 levels, evaluating them intraindividually by Spearman's rank correlation test. Finally, a significant correlation was found between CCL24 and CCL26 levels and the percentage of eosinophilic infiltration of nasal mucosa. Our data suggest that CCL26 and CCL24 are likely involved in the pathogenesis of chronic nasal hypereosinophilia, with a complex cooperation and different involvement of the various members of eotaxin family. Further

  11. [The value of sinonasal CT scan in diagnosing of eosinophilic chronic rhinosinusitis with nasal polyps].

    PubMed

    Meng, Y F; Lou, H F; Wang, C S; Zhang, L

    2017-02-07

    Objective: To compare the value of sinonasal CT scan with other clinical parameters in the pre-diagnosis of eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP). Methods: From January to May of 2016, One hundred and fifty consecutive CRSwNP patients (90 eCRSwNP and 60 non-eosinophilic CRSwNP) undergoing endoscopic functional sinus surgery in Beijing Tongren Hospital were recruited in this study. Preoperative CT scan, skin prick test (SPT) and oral fractional exhaled nitric oxide (FeNO) measurements were performed in each patient and full blood count with differential analysis was performed within 1 week before surgery. t test and X2 test were used to compare the age, gender, history of surgery, onset of asthma, history of allergy, CT scores' ratio for the ethmoid sinus and maxillary sinus (E/M ratio) and presence of osteoneogenesis of two groups. Mann-Whitney analysis was used to compare the total Lund-Mackay scores, FeNO and blood eosinophil counts of two groups. Logistic regression analysis and receiver operating characteristic (ROC) curve were used to assess the predictive value of clinical parameters. Results: E/M ratio, FeNO, blood eosinophil percentage of eCRSwNP group was significantly higher than those of non-eosinophilic CRSwNP group [3.56±0.37 vs 1.80±0.10, (34.4±18.1) μg/L vs (22.1±11.7) μg/L, 8.19%±1.50% vs 4.55%±5.60%; χ(2) value was 0.900; t value was 0.994 and 0.900, respectively; all P<0.05]. E/M ratio had the highest predictive value, with area under curve (AUC) value of 0.938. The cut-off point of 2.59 for E/M ratio demonstrated a sensitivity of 94.3% and a specificity of 89.6% for eCRSwNP. Conclusion: The E/M ratio is a more useful predictor in the diagnosis of eCRSwNP compared to other clinical parameters.

  12. Sinonasal inhalation of tobramycin vibrating aerosol in cystic fibrosis patients with upper airway Pseudomonas aeruginosa colonization: results of a randomized, double-blind, placebo-controlled pilot study

    PubMed Central

    Mainz, Jochen G; Schädlich, Katja; Schien, Claudia; Michl, Ruth; Schelhorn-Neise, Petra; Koitschev, Assen; Koitschev, Christiane; Keller, Peter M; Riethmüller, Joachim; Wiedemann, Baerbel; Beck, James F

    2014-01-01

    Rationale In cystic fibrosis (CF), the paranasal sinuses are sites of first and persistent colonization by pathogens such as Pseudomonas aeruginosa. Pathogens subsequently descend to the lower airways, with P. aeruginosa remaining the primary cause of premature death in patients with the inherited disease. Unlike conventional aerosols, vibrating aerosols applied with the PARI Sinus™ nebulizer deposit drugs into the paranasal sinuses. This trial assessed the effects of vibrating sinonasal inhalation of the antibiotic tobramycin in CF patients positive for P. aeruginosa in nasal lavage. Objectives To evaluate the effects of sinonasal inhalation of tobramycin on P. aeruginosa quantification in nasal lavage; and on patient quality of life, measured with the Sino-Nasal Outcome Test (SNOT-20), and otologic and renal safety and tolerability. Methods Patients were randomized to inhalation of tobramycin (80 mg/2 mL) or placebo (2 mL isotonic saline) once daily (4 minutes/nostril) with the PARI Sinus™ nebulizer over 28 days, with all patients eligible for a subsequent course of open-label inhalation of tobramycin for 28 days. Nasal lavage was obtained before starting and 2 days after the end of each treatment period by rinsing each nostril with 10 mL of isotonic saline. Results Nine patients participated, six initially receiving tobramycin and three placebo. Sinonasal inhalation was well tolerated, with serum tobramycin <0.5 mg/L and stable creatinine. P. aeruginosa quantity decreased in four of six (67%) patients given tobramycin, compared with zero of three given placebo (non-significant). SNOT-20 scores were significantly lower in the tobramycin than in the placebo group (P=0.033). Conclusion Sinonasal inhalation of vibrating antibiotic aerosols appears promising for reducing pathogen colonization of paranasal sinuses and for control of symptoms in patients with CF. PMID:24596456

  13. Sixty-Three Patients Based Survey - Can Sinonasal Outcome Test-22 Be a Suitable Evaluation Method for Septoplasty and Turbinectomy?

    PubMed

    Kordjian, Hayarpi H; Schousboe, Lars P

    2017-04-01

    In this study we evaluated the patient-perceived benefit of surgery for nasal obstruction. Data were collected prospectively from both sexes of all ages who underwent elective surgery for nasal obstruction. All patients completed Sinonasal Outcome Test-22 (SNOT-22) questionnaire pre- and postoperatively. During the study period 63 subjects underwent surgery for nasal obstruction (septoplasty and/or turbinectomy). The median total SNOT-22 score was 35 and 14 pre- and postoperatively, respectively. The median difference between post- and preoperative scores was -15. We did not find significant correlation between changes in SNOT-22 scores postoperatively and age, gender, follow-up time, operation type or survey method. We can carefully conclude that SNOT-22 can be a useful instrument for patients undergoing operation for nasal obstruction. This article is protected by copyright. All rights reserved.

  14. Sinonasal NUT-Midline Carcinoma – A Multimodality Approach to Diagnosis, Staging and Post-Surgical Restaging

    PubMed Central

    Pagedar, Nitin; Awan, Omer; McNeely, Parren

    2015-01-01

    Nuclear protein testis (NUT) midline carcinoma is a rare malignancy involving predominantly the midline structures of the body. It is characterized by its genotypic feature of BRD4-NUT translocation, which is in contrast with other malignant processes that are usually categorized based on their histologic/phenotypic features. As these tumors may vary in their histologic presentation, they can be misdiagnosed as poorly differentiated carcinomas. Moreover, they are often very aggressive and associated with high mortality. Therefore, it is extremely important to diagnose them early using computed tomography (CT) and magnetic resonance imaging (MRI) and perform staging and restaging using 18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG PET/CT), in addition to accurately identifying them at a microscopic and molecular level. We report a unique case of a sinonasal NUT midline carcinoma that was diagnosed with CT, staged with PET/CT, and restaged using PET/CT and MRI. PMID:26244120

  15. [Prospectic evaluation of the Italian Workers' Compensation Authority in a large case series of Occupational sino-nasal cancers].

    PubMed

    Casà, M; Bonzini, M; Parassoni, D; Tavecchio, D; Facchinetti, N; Castelnuovo, P; Ferrario, M M

    2012-01-01

    Sino-nasal cancer (SNC) are rare tumours with an elevated occupational etiological fraction, due both to well-established risk factors (wood and leather) and to more rare carcinogens. We evaluated the assessment for workers' compensation performed by the Italian Authority (INAL) in a case-series of occupational SNC (N = 45). We observed an elevated proportion of cases that were recognised as occupational, overall (36 on 39) and for any histotype. INAIL tended to recognize as professional not only patients with exposure to wood and leather but also cases with a documented exposure to formaldehyde, metal, polycyclic hydrocarbons. Significant differences across Italian macro-regions appeared, when the amount of worker compensation was investigated.

  16. National trends in surgery for sinonasal malignancy and the effect of hospital volume on short-term outcomes.

    PubMed

    Ouyang, David; El-Sayed, Ivan H; Yom, Sue S

    2014-07-01

    To characterize trends in the management of sinonasal malignancy with a focus on the impact of hospital volume on surgical outcomes. Retrospective cohort study. Time trends were analyzed among patients admitted for surgical resection of sinonasal malignancy in the Nationwide Inpatient Sample (NIS) between 1988 and 2009. Subset analysis was performed on cohorts with skull base or orbital involvement or on cohorts who underwent neck dissection. Patient characteristics and hospital attributes were correlated with morbidity and mortality. Over 22 years, we identified 3,850 cases from 879 hospitals. A total of 24.3% of patients had complications and 0.8% of hospitalizations resulted in mortality. Cases with skull base or orbital involvement, or cases including neck dissection, had more complications and a longer length of stay. Prevalence of neck dissection increased over time. Thirty-two hospitals averaged more than five cases per year, accounting for 28% of all surgeries. These centers were large (73.3%), urban (96.7%), teaching (90%) institutions and performed more high-risk cases: 32.4% of neck dissections, 44.6% of orbital cases, and 43.1% of skull base cases. Compared to lower-volume centers, these centers had more cardiopulmonary and electrolyte complications, but no difference was observed in the lengths of stay. A greater proportion of cases were recently performed at high-volume centers. Over time, complicated surgeries were more likely to occur at higher-volume hospitals without significant changes in surgical complication rates. High-volume centers had increased rates of cardiopulmonary and electrolyte complications, likely representing complex postoperative management, but these were not associated with higher mortality. 2c. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Bacterial d-amino acids suppress sinonasal innate immunity through sweet taste receptors in solitary chemosensory cells.

    PubMed

    Lee, Robert J; Hariri, Benjamin M; McMahon, Derek B; Chen, Bei; Doghramji, Laurel; Adappa, Nithin D; Palmer, James N; Kennedy, David W; Jiang, Peihua; Margolskee, Robert F; Cohen, Noam A

    2017-09-05

    In the upper respiratory epithelium, bitter and sweet taste receptors present in solitary chemosensory cells influence antimicrobial innate immune defense responses. Whereas activation of bitter taste receptors (T2Rs) stimulates surrounding epithelial cells to release antimicrobial peptides, activation of the sweet taste receptor (T1R) in the same cells inhibits this response. This mechanism is thought to control the magnitude of antimicrobial peptide release based on the sugar content of airway surface liquid. We hypothesized that d-amino acids, which are produced by various bacteria and activate T1R in taste receptor cells in the mouth, may also activate T1R in the airway. We showed that both the T1R2 and T1R3 subunits of the sweet taste receptor (T1R2/3) were present in the same chemosensory cells of primary human sinonasal epithelial cultures. Respiratory isolates of Staphylococcus species, but not Pseudomonas aeruginosa, produced at least two d-amino acids that activate the sweet taste receptor. In addition to inhibiting P. aeruginosa biofilm formation, d-amino acids derived from Staphylococcus inhibited T2R-mediated signaling and defensin secretion in sinonasal cells by activating T1R2/3. d-Amino acid-mediated activation of T1R2/3 also enhanced epithelial cell death during challenge with Staphylococcus aureus in the presence of the bitter receptor-activating compound denatonium benzoate. These data establish a potential mechanism for interkingdom signaling in the airway mediated by bacterial d-amino acids and the mammalian sweet taste receptor in airway chemosensory cells. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

  18. A pilot study for segmentation of pharyngeal and sino-nasal airway subregions by automatic contour initialization.

    PubMed

    Neelapu, Bala Chakravarthy; Kharbanda, Om Prakash; Sardana, Viren; Gupta, Abhishek; Vasamsetti, Srikanth; Balachandran, Rajiv; Rana, Shailendra Singh; Sardana, Harish Kumar

    2017-07-28

    The objective of the present study is to put forward a novel automatic segmentation algorithm to segment pharyngeal and sino-nasal airway subregions on 3D CBCT imaging datasets. A fully automatic segmentation of sino-nasal and pharyngeal airway subregions was implemented in MATLAB programing environment. The novelty of the algorithm is automatic initialization of contours in upper airway subregions. The algorithm is based on boundary definitions of the human anatomy along with shape constraints with an automatic initialization of contours to develop a complete algorithm which has a potential to enhance utility at clinical level. Post-initialization; five segmentation techniques: Chan-Vese level set (CVL), localized Chan-Vese level set (LCVL), Bhattacharya distance level set (BDL), Grow Cut (GC), and Sparse Field method (SFM) were used to test the robustness of automatic initialization. Precision and F-score were found to be greater than 80% for all the regions with all five segmentation methods. High precision and low recall were observed with BDL and GC techniques indicating an under segmentation. Low precision and high recall values were observed with CVL and SFM methods indicating an over segmentation. A Larger F-score value was observed with SFM method for all the subregions. Minimum F-score value was observed for naso-ethmoidal and sphenoidal air sinus region, whereas a maximum F-score was observed in maxillary air sinuses region. The contour initialization was more accurate for maxillary air sinuses region in comparison with sphenoidal and naso-ethmoid regions. The overall F-score was found to be greater than 80% for all the airway subregions using five segmentation techniques, indicating accurate contour initialization. Robustness of the algorithm needs to be further tested on severely deformed cases and on cases with different races and ethnicity for it to have global acceptance in Katradental radKatraiology workflow.

  19. Treatment of gastric ulcers and diarrhea with the Amazonian herbal medicine sangre de grado.

    PubMed

    Miller, M J; MacNaughton, W K; Zhang, X J; Thompson, J H; Charbonnet, R M; Bobrowski, P; Lao, J; Trentacosti, A M; Sandoval, M

    2000-07-01

    Sangre de grado is an Amazonian herbal medicine used to facilitate the healing of gastric ulcers and to treat gastritis, diarrhea, skin lesions, and insect stings. This study was designed to evaluate the gastrointestinal applications. Gastric ulcers were induced in rats by brief serosal exposure of the fundus to acetic acid (80%). Sangre de grado was administered in drinking water at 1:1,000 and 1:10,000 dilutions from the postoperative period to day 7. Guinea pig ileum secretory responses to capsaicin, electrical field stimulation, and the neurokinin-1 (NK-1) agonist [Sar(9),Met(O(2))(11)]substance P were examined in Ussing chambers. Sangre de grado facilitated the healing of experimental gastric ulcer, reducing myeloperoxidase activity, ulcer size, and bacterial content of the ulcer. The expression of proinflammatory genes tumor necrosis factor-alpha, inducible nitric oxide synthase (iNOS), interleukin (IL)-1beta, IL-6, and cyclooxygenase-2 was upregulated by ulcer induction but reduced by sangre de grado treatment, particularly iNOS and IL-6. In Ussing chambers, sangre de grado impaired the secretory response to capsaicin but not to electrical field stimulation or the NK-1 agonist. We conclude that sangre de grado is a potent, cost-effective treatment for gastrointestinal ulcers and distress via antimicrobial, anti-inflammatory, and sensory afferent-dependent actions.

  20. Assessment of airflow ventilation in human nasal cavity and maxillary sinus before and after targeted sinonasal surgery: a numerical case study.

    PubMed

    Zhu, Jian Hua; Lim, Kian Meng; Thong, Kim Thye Mark; Wang, De Yun; Lee, Heow Pueh

    2014-04-01

    In this study, we evaluated the effects of targeted sinonasal surgery on nasal and maxillary sinus airflow patterns. A patient, who underwent right balloon sinuplasty and left uncinectomy for recurrent maxillary sinus barometric pressure, and concomitant septoplasty and bilateral inferior turbinate reduction for deviated nasal septum and inferior turbinate hypertrophy, was selected. Two 3D models representing both pre- and post-operative sinonasal morphology were constructed. The models were then used to evaluate nasal and maxillary sinus airflow patterns during respiration at ventilation rates of 7.5 L/min, 15 L/min and 30 L/min using computational fluid dynamics. The results showed that septoplasty and inferior turbinate reduction increased the nasal volume by 13.6%. The airflow patterns in the nasal cavity showed reasonably decreased resistance and slightly more even flow partitioning after the operation. Maxillary sinus ventilation significantly increased during inspiration in the left sinus after uncinectomy, and during expiration in right sinus after balloon sinuplasty. This study demonstrates computational fluid dynamics simulation is a tool in the investigation of outcomes after targeted, minimally invasive sinonasal surgery. Copyright © 2014. Published by Elsevier B.V.

  1. Long-term quality of life after endoscopic removal of sinonasal inverted papillomas: a 6-year cohort analysis in a tertiary academic hospital.

    PubMed

    van Samkar, Anusha; Georgalas, Christos

    2016-06-01

    Inverted papillomas may affect the (para)nasal cavity. While some of these papillomas can undergo malignant transformation, others grow slowly and cause few if any symptoms. An endoscopic approach is seen as providing a balance between the greatest removal possible and avoiding unnecessary morbidity. However, the actual long-term quality of life of patients having undergone surgery for inverted papillomas has never been studied. Our primary aim is to assess the long-term sequelae and the quality of life of patients after endoscopic surgery of sinonasal inverted papillomas. The secondary aim is to establish which nasal symptoms, if any, are the most prevalent before and after surgery. We used the SNOT-22 questionnaire to assess the quality of life of patients who had undergone endoscopic surgery for sinonasal inverted papillomas between 2000 and 2011. Twenty-seven out of 34 patients returned the questionnaire (79 % response rate). Median follow-up was 6 years (range 1-10). Mean age was 58.9 years (range 40-85). Median SNOT-22 score was 12, while the most frequent postoperative symptom was the need to blow the nose (18 patients) and the most frequent preoperative symptom was nasal obstruction. Patients after endoscopic removal of sinonasal inverted papillomas return to an almost normal quality of life, as measured by the disease-specific questionnaire SNOT-22. The most frequent symptom was the need to blow the nose.

  2. Inhibition of neurogenic inflammation by the Amazonian herbal medicine sangre de grado.

    PubMed

    Miller, M J; Vergnolle, N; McKnight, W; Musah, R A; Davison, C A; Trentacosti, A M; Thompson, J H; Sandoval, M; Wallace, J L

    2001-09-01

    This study was designed to determine if the Amazonian medicinal sangre de grado, confers benefit by suppressing the activation of sensory afferent nerves. (i) vasorelaxation of rat mesenteric arteries in response to calcitonin gene-related peptide; (ii) rat paw edema in response to protease- activating peptide receptor 2-activating peptide; (iii) rat paw hyperalgesia in response to low-dose protease-activating peptide receptor 2-activating peptide or prostaglandin E2; (iv) gastric hyperemia in response luminal capsaicin; (v) a clinical trial of a sangre de grado balm in pest control workers. The parent botanical was fractionated for evaluation of potential active components. In preconstricted rat mesenteric arteries, highly diluted sangre de grado (1:10,000) caused a shift to the right of the calcitonin gene-related peptide dose-response curve (p < 0.01). Paw edema in response to protease-activating peptide receptor 2-activating peptide (500 microg) was reduced by as single topical administration sangre de grado balm (1% concentration, p < 0.01) for at least 6 h. Hyperalgesia induced by either low-dose protease-activating peptide receptor 2-activating peptide (50 microg) or prostaglandin E2 was prevented by sangre de grado balm. A fraction possessing analgesic and capsaicin antagonistic properties was isolated and high-performance liquid chromatography and gas chromatography-mass spectrometry analysis indicated that it was a proanthocyandin oligomer. In pest control workers, sangre de grado balm (Zangrado) was preferred over placebo, for the relief of itching, pain, discomfort, edema, and redness in response to wasps, fire ants, mosquitoes, bees, cuts, abrasions, and plant reactions. Subjects reported relief within minutes. We conclude that sangre de grado is a potent inhibitor of sensory afferent nerve mechanisms and supports its ethnomedical use for disorders characterized by neurogenic inflammation.

  3. Predicting location of recurrence using FDG, FLT, and Cu-ATSM PET in canine sinonasal tumors treated with radiotherapy

    NASA Astrophysics Data System (ADS)

    Bradshaw, Tyler; Fu, Rau; Bowen, Stephen; Zhu, Jun; Forrest, Lisa; Jeraj, Robert

    2015-07-01

    Dose painting relies on the ability of functional imaging to identify resistant tumor subvolumes to be targeted for additional boosting. This work assessed the ability of FDG, FLT, and Cu-ATSM PET imaging to predict the locations of residual FDG PET in canine tumors following radiotherapy. Nineteen canines with spontaneous sinonasal tumors underwent PET/CT imaging with radiotracers FDG, FLT, and Cu-ATSM prior to hypofractionated radiotherapy. Therapy consisted of 10 fractions of 4.2 Gy to the sinonasal cavity with or without an integrated boost of 0.8 Gy to the GTV. Patients had an additional FLT PET/CT scan after fraction 2, a Cu-ATSM PET/CT scan after fraction 3, and follow-up FDG PET/CT scans after radiotherapy. Following image registration, simple and multiple linear and logistic voxel regressions were performed to assess how well pre- and mid-treatment PET imaging predicted post-treatment FDG uptake. R2 and pseudo R2 were used to assess the goodness of fits. For simple linear regression models, regression coefficients for all pre- and mid-treatment PET images were significantly positive across the population (P < 0.05). However, there was large variability among patients in goodness of fits: R2 ranged from 0.00 to 0.85, with a median of 0.12. Results for logistic regression models were similar. Multiple linear regression models resulted in better fits (median R2 = 0.31), but there was still large variability between patients in R2. The R2 from regression models for different predictor variables were highly correlated across patients (R ≈ 0.8), indicating tumors that were poorly predicted with one tracer were also poorly predicted by other tracers. In conclusion, the high inter-patient variability in goodness of fits indicates that PET was able to predict locations of residual tumor in some patients, but not others. This suggests not all patients would be good candidates for dose painting based on a single biological target.

  4. The role of radiotherapy in the management of sinonasal melanoma and its impact on patients and healthcare professionals.

    PubMed

    Moore, A

    2014-11-01

    The aim of this paper is discuss the contemporary issues surrounding radiotherapy for sinonasal mucosal melanoma (SNMM). SNMM is a rare disease with a poor prognosis. The particular challenge with regard to radiotherapy for SNMM is that melanoma is a relatively radioresistant tumour in an anatomical site surrounded by important radiosensitive structures. IMRT has been shown to be an effective primary and adjuvant therapy, and is superior to traditional photon radiotherapy techniques. Emerging evidence also supports the role of particle therapy. Protons and carbon ions may provide a superior target dose and less collateral damage than IMRT. Stereotactic radiotherapy has also been used successfully. The introduction of new technology will always be inhibited by financial constraints and concerns about long-term efficacy. The role of the health professional will change commensurate with the introduction of new technology in terms of the knowledge and the clinical skills they must acquire. Working patterns may need to change to manage the competing interests of expanding services and financial cutbacks. In addition to the clinical expertise health professionals provide, they will be charged with the responsibility of finding innovative ways to improve and develop radiotherapy services for SNMM.

  5. Sinonasal oncocytic Schneiderian papilloma accompanied by intravascular lymphoma: A case report on FDG-PET/CT imaging.

    PubMed

    Koyama, Masamichi; Terauchi, Takashi; Koizumi, Mitsuru; Tanaka, Hiroko; Takeuchi, Kengo

    2016-08-01

    F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is useful for the staging and assessment of treatment response in patients with lymphoma. Occasionally, benign lesions demonstrate avid FDG uptake and result in false positive findings. We report the case of an 82-year-old man presenting with cutaneous lesions, which were histopathologically diagnosed as intravascular lymphoma. FDG-PET/CT for staging demonstrated an FDG-avid mass extending from the right maxillary sinus to the nasal cavity, moderate uptake in the adrenal glands, mild uptake in the knee and the foot, and faint uptake in the skin and subcutaneous tissue of the legs. He subsequently underwent biopsy of the paranasal mass, which was diagnosed as oncocytic Schneiderian papilloma without lymphoma invasion. Glucose transporter (GLUT) 1 staining was highly positive in the papilloma cells, resulting in high FDG avidity. After completion of chemotherapy, the abnormal FDG uptakes in the skin, soft tissue, and adrenal glands disappeared on PET/CT. However, avid FDG uptake persisted in the sinonasal Schneiderian papilloma for 15 months before regression. Benign tumors with oncocytic components may show avid FDG uptake. Therefore, correct diagnosis of oncocytic Schneiderian papilloma on FDG images is difficult when other accompanying malignant tumors, especially lymphoma, are present. If post-therapeutic PET/CT images show a discordant lesion, oncocytic tumors, albeit uncommon, should be considered in the differential diagnoses.

  6. Combined small cell carcinoma of the sinonasal tract associated with syndrome of inappropriate secretion of antidiuretic hormone: A case report

    PubMed Central

    KAYAKABE, MIKIKO; TAKAHASHI, KATSUMASA; OKAMIYA, TOMOFUMI; SEGAWA, ATSUKI; OYAMA, TETSUNARI; CHIKAMATSU, KAZUAKI

    2014-01-01

    Combined small cell carcinoma (SmCC) and squamous cell carcinoma (SqCC) is a rare malignant neoplasm in the head and neck. This study presents the first reported case of combined SmCC and SqCC originating from the sinonasal tract accompanied by syndrome of inappropriate secretion of antidiuretic hormone (SIADH). An 80-year-old female presented with a four-week history of right nasal discharge, nasal obstruction and left neck swelling. Imaging studies revealed a tumorous lesion in the maxillary sinus encroaching upon the right nasal cavity and left cervical lymph node (LN) swelling. An incisional biopsy carried out from the right maxillary sinus and LNs resulted in a diagnosis of combined SmCC with SqCC, staged as T4aN2cM0. Clinical examination revealed a sustained increase of antidiuretic hormone, hyponatremia with urinary sodium increase, and serum hypo-osmosis, resulting in SIADH. Water restriction to <1,000 ml/day was effective in improving sodium and osmotic imbalance. Curative treatment for the tumor was not prescribed due to the poor condition of the patient. Palliative treatment was administered and the patient succumbed to cachexia five months after histological diagnosis. The presence of SIADH may have marked implications for the treatment and prognosis of this disease. PMID:24944702

  7. The dragonfly splint: a new disposable device designed to prevent both medial and lateral turbinate synechiae after sinonasal surgery.

    PubMed

    Mantovani, Mario; Rinaldi, Vittorio; Torretta, Sara; Sigismund, Paolo Enrico; Cappadona, Maurizio; Minetti, Andrea; Pignataro, Lorenzo

    2014-03-01

    Periturbinal adhesions are among the most frequent and challenging complications of sinonasal surgery. Endonasal paraseptal splints have proved to be very efficient in preventing "medial synechiae," that is, adhesions located between the medial faces of the middle/inferior turbinates and the septum. However, none of these devices for guiding mucosal healing can prevent "lateral synechiae" (adhesions between the lateral face of the middle turbinate and the lateral nasal wall) inside the middle meatal cleft, which is a very critical area for the physiology of the anterior sinus system. For this reason, if followed by the formation of lateral synechiae, the surgical maneuvers used to treat sinus diseases could paradoxically become a cause of persistent functional impairment and lead to iatrogenic sinusitis or mucocele.We describe our preliminary experience with a new endonasal splint called "Dragonfly" (because of its shape), which has been designed to prevent both medial and lateral postsurgical synechiae. This device has a long lateral wing designed to separate the mucosal surfaces of the middle meatal/ethmoid cavities and prevent adhesions during the postoperative process of healing. The device must be kept in situ for 3 to 4 weeks to permit the re-epithelialization of the internal nasal surfaces. Our experience shows that the splints are well tolerated and highly efficient, preventing both medial and lateral synechiae in 100% of cases. A randomized controlled study has now been started to confirm these positive preliminary findings in a larger patient population.

  8. Combined small cell carcinoma of the sinonasal tract associated with syndrome of inappropriate secretion of antidiuretic hormone: A case report.

    PubMed

    Kayakabe, Mikiko; Takahashi, Katsumasa; Okamiya, Tomofumi; Segawa, Atsuki; Oyama, Tetsunari; Chikamatsu, Kazuaki

    2014-04-01

    Combined small cell carcinoma (SmCC) and squamous cell carcinoma (SqCC) is a rare malignant neoplasm in the head and neck. This study presents the first reported case of combined SmCC and SqCC originating from the sinonasal tract accompanied by syndrome of inappropriate secretion of antidiuretic hormone (SIADH). An 80-year-old female presented with a four-week history of right nasal discharge, nasal obstruction and left neck swelling. Imaging studies revealed a tumorous lesion in the maxillary sinus encroaching upon the right nasal cavity and left cervical lymph node (LN) swelling. An incisional biopsy carried out from the right maxillary sinus and LNs resulted in a diagnosis of combined SmCC with SqCC, staged as T4aN2cM0. Clinical examination revealed a sustained increase of antidiuretic hormone, hyponatremia with urinary sodium increase, and serum hypo-osmosis, resulting in SIADH. Water restriction to <1,000 ml/day was effective in improving sodium and osmotic imbalance. Curative treatment for the tumor was not prescribed due to the poor condition of the patient. Palliative treatment was administered and the patient succumbed to cachexia five months after histological diagnosis. The presence of SIADH may have marked implications for the treatment and prognosis of this disease.

  9. A simple optimization approach for improving target dose homogeneity in intensity-modulated radiotherapy for sinonasal cancer

    PubMed Central

    Lu, Jia-Yang; Zhang, Ji-Yong; Li, Mei; Cheung, Michael Lok-Man; Li, Yang-Kang; Zheng, Jing; Huang, Bao-Tian; Zhang, Wu-Zhe

    2015-01-01

    Homogeneous target dose distribution in intensity-modulated radiotherapy (IMRT) for sinonasal cancer (SNC) is challenging to achieve. To solve this problem, we established and evaluated a basal-dose-compensation (BDC) optimization approach, in which the treatment plan is further optimized based on the initial plans. Generally acceptable initial IMRT plans for thirteen patients were created and further optimized individually by (1) the BDC approach and (2) a local-dose-control (LDC) approach, in which the initial plan is further optimized by addressing hot and cold spots. We compared the plan qualities, total planning time and monitor units (MUs) among the initial, BDC, LDC IMRT plans and volumetric modulated arc therapy (VMAT) plans. The BDC approach provided significantly superior dose homogeneity/conformity by 23%–48%/6%–9% compared with both the initial and LDC IMRT plans, as well as reduced doses to the organs at risk (OARs) by up to 18%, with acceptable MU numbers. Compared with VMAT, BDC IMRT yielded superior homogeneity, inferior conformity and comparable overall OAR sparing. The planning of BDC, LDC IMRT and VMAT required 30, 59 and 58 minutes on average, respectively. Our results indicated that the BDC optimization approach can achieve significantly better dose distributions with shorter planning time in the IMRT for SNC. PMID:26497620

  10. A simple optimization approach for improving target dose homogeneity in intensity-modulated radiotherapy for sinonasal cancer.

    PubMed

    Lu, Jia-Yang; Zhang, Ji-Yong; Li, Mei; Cheung, Michael Lok-Man; Li, Yang-Kang; Zheng, Jing; Huang, Bao-Tian; Zhang, Wu-Zhe

    2015-10-26

    Homogeneous target dose distribution in intensity-modulated radiotherapy (IMRT) for sinonasal cancer (SNC) is challenging to achieve. To solve this problem, we established and evaluated a basal-dose-compensation (BDC) optimization approach, in which the treatment plan is further optimized based on the initial plans. Generally acceptable initial IMRT plans for thirteen patients were created and further optimized individually by (1) the BDC approach and (2) a local-dose-control (LDC) approach, in which the initial plan is further optimized by addressing hot and cold spots. We compared the plan qualities, total planning time and monitor units (MUs) among the initial, BDC, LDC IMRT plans and volumetric modulated arc therapy (VMAT) plans. The BDC approach provided significantly superior dose homogeneity/conformity by 23%-48%/6%-9% compared with both the initial and LDC IMRT plans, as well as reduced doses to the organs at risk (OARs) by up to 18%, with acceptable MU numbers. Compared with VMAT, BDC IMRT yielded superior homogeneity, inferior conformity and comparable overall OAR sparing. The planning of BDC, LDC IMRT and VMAT required 30, 59 and 58 minutes on average, respectively. Our results indicated that the BDC optimization approach can achieve significantly better dose distributions with shorter planning time in the IMRT for SNC.

  11. Developing a model for the mercury cycle in the Marano-Grado Lagoon (Italy)

    EPA Science Inventory

    The Marano-Grado Lagoon is a wetland system of about 160 km2 located in the Northern Adriatic Sea (Italy) between the Tagliamento and the Isonzo River mouths. The lagoon morphology and biogeochemistry are primarily controlled by the exchange with the Adriatic Sea and, to a lesser...

  12. Taspine is the cicatrizant principle in Sangre de Grado extracted from Croton lechleri.

    PubMed

    Vaisberg, A J; Milla, M; Planas, M C; Cordova, J L; de Agusti, E R; Ferreyra, R; Mustiga, M C; Carlin, L; Hammond, G B

    1989-04-01

    Sangre de Grado extract used by Peruvian natives as a cicatrizant agent, was collected from trees of the species Croton lechleri growing in the Peruvian jungle. The Sangre de Grado was found to contain one alkaloid identified as taspine and which was shown to be the active cicatrizant principle by an in vivo test in mice. This alkaloid exhibited a dose-related cicatrizant effect and an ED50 of 0.375 mg/kg. Experiments with taspine hydrochloride in order to study its mechanism of action in cell culture systems showed that the alkaloid was non-toxic to human foreskin fibroblasts at concentrations below 150 ng/ml and that it had no effect on cell proliferation. On the other hand, taspine hydrochloride was found to increase the migration of human foreskin fibroblasts. This effect on the migration of fibroblasts is probably the mechanism by which Sangre de Grado and taspine hydrochloride accelerate the wound healing process. Using the two-stage mouse skin carcinogenesis system, we have been able to show that neither Sangre de Grado nor taspine hydrochloride had carcinogenic or tumour promoter activity after 17 months of treatment.

  13. Developing a model for the mercury cycle in the Marano-Grado Lagoon (Italy)

    EPA Science Inventory

    The Marano-Grado Lagoon is a wetland system of about 160 km2 located in the Northern Adriatic Sea (Italy) between the Tagliamento and the Isonzo River mouths. The lagoon morphology and biogeochemistry are primarily controlled by the exchange with the Adriatic Sea and, to a lesser...

  14. Oncogene abnormalities in a series of primary melanomas of the sinonasal tract: NRAS mutations and cyclin D1 amplification are more frequent than KIT or BRAF mutations.

    PubMed

    Chraybi, Meriem; Abd Alsamad, Issam; Copie-Bergman, Christiane; Baia, Maryse; André, Jocelyne; Dumaz, Nicolas; Ortonne, Nicolas

    2013-09-01

    Primary malignant melanoma of sinonasal tract is a rare but severe form of melanoma. We retrospectively analyzed 17 cases and focused on the histologic presentation and the expression of c-Kit, epidermal growth factor receptor (EGFR), cyclin D1/Bcl-1, PS100, and HMB45 and searched for BRAF, NRAS, and KIT mutations that are known to be associated with melanoma subtypes, together with amplifications of KIT, cyclin D1, cyclin-dependent kinase 4, MDM2, and microphthalmia-associated transcription factor using quantitative polymerase chain reaction. In most cases (78%), an in situ component was evidenced. Invasive components were composed of diffuse areas of rhabdoid, epithelioid, or spindle cells and, in most cases, lacked inflammatory reaction, suggesting that an immune escape phenomenon probably develops when the disease progresses. EGFR was rarely and weakly expressed in the in situ component of 2 cases. None of the investigated case showed BRAF V600E, but 1 had a D594G mutation. NRAS mutations in exon 2 (G12D or G12A) were found in 3 cases (18%), and a KIT mutation in exon 11 (L576P), in 1, whereas c-Kit was expressed at the protein level in half of the cases. Amplifications of cyclin D1 were evidenced in 5 cases, confirmed in 3 by fluorescence in situ hybridization, but this was not always correlated with protein expression, found in 8 patients (62.5%), 3 having no significant amplification. In conclusion, primary malignant melanoma of sinonasal tract is not associated with BRAF V600E mutations. Instead, NRAS or KIT mutations and cyclin D1 amplification can be found in a proportion of cases, suggesting that primary malignant melanoma of sinonasal tract is heterogeneous at the molecular level and should not be sensitive to therapeutic approaches aiming at BRAF.

  15. SMARCB1/INI1-deficient sinonasal carcinoma shows methylation of RASSF1 gene: A clinicopathological, immunohistochemical and molecular genetic study of a recently described entity.

    PubMed

    Laco, Jan; Chmelařová, Marcela; Vošmiková, Hana; Sieglová, Kateřina; Bubancová, Ivana; Dundr, Pavel; Němejcová, Kristýna; Michálek, Jaroslav; Čelakovský, Petr; Mottl, Radovan; Sirák, Igor; Vošmik, Milan; Ryška, Aleš

    2017-02-01

    The aim of the study was detailed clinicopathological investigation of SMARCB1/INI1-deficient sinonasal carcinomas, including molecular genetic analysis of mutational status and DNA methylation of selected protooncogenes and tumor suppressor genes by means of next generation sequencing (NGS) and methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA). A total of 4/56 (7%) cases of SMARCB1/INI1-deficient carcinomas were detected among 56 sinonasal carcinomas diagnosed over a 19year period using immunohistochemical screening. The series comprised 3 males and 1 female, aged 27-76 years (median 64 years). All tumors arose in the nasal cavity. Three neoplasms were diagnosed in advanced stage pT4. During the follow-up period (range 14-111 months (median 72 months)), three tumors recurred locally, but none of the patients developed regional or distant metastases. Ultimately, two patients died due to the tumor. Microscopically, all tumors consisted of infiltrating nests of polygonal basaloid cells with a variable component of rhabdoid cells with eosinophilic cytoplasm. Immunohistochemically, there was almost diffuse expression of cytokeratins (CK), p16, p40 and p63 in all cases, while expression of CK5/6, CK7 and vimentin was only focal or absent. The detection of NUT gave negative results. In three cases, the absence of SMARCB1/INI1 expression was due to deletion of SMARCB1/INI1 gene. Methylation of SMARCB1/INI1 gene was not found. One tumor harbored HPV18 E6/E7 mRNA. All 12 genes (BRAF, BRCA1, BRCA2, KIT, EGFR, KRAS, NRAS, PDGFRA, PIK3CA, PTEN, RET, and ROS1) tested for mutations using NGS were wild-type. Regarding DNA methylation, all four SMARCB1/INI1-deficient tumors showed methylation of RASSF1 gene by means of MS-MLPA. There was a statistically significant difference in RASSF1 gene methylation between SMARCB1/INI1-deficient and SMARCB1/INI1-positive tumors (p=0.0095). All other examined genes (ATM, BRCA1, BRCA2, CADM1, CASP8, CD44, CDKN1B

  16. [Viral infection of herpes simplex, Epstein-Barr, varicela zoster, human papilloma, cytomegalovirus, or adenovirus are not related to sinonasal adenocarcinomas].

    PubMed

    Pérez Escuredo, Jhudit; Llorente, José Luis; Melón, Santiago; de Oña, María; García Martínez, Jorge; Alvarez Marcos, César; Hermsen, Mario

    2007-01-01

    Several types of virus have been implicated in the development of head and neck tumors. However, until now sinonasal adenocarcinomas (ACN) have not been studied. The aim of this study is to screen a series of ACN for the presence of a number of viruses known to play a role in cancer. Viral DNA sequences of herpes simplex virus, Epstein-Barr, varicela zoster, human papilloma, cytomegalovirus, and adenovirus were analysed by PCR in 37 primary ACN. Three tumors (8.1%) were positive for Epstein-Barr virus and 1 case (2.7%) for cytomegalovirus. Viral infections do not seem to play a role in the etiology of ACN.

  17. The Making of a Skull Base Team and the Value of Multidisciplinary Approach in the Management of Sinonasal and Ventral Skull Base Malignancies.

    PubMed

    Snyderman, Carl H; Wang, Eric W; Fernandez-Miranda, Juan C; Gardner, Paul A

    2017-04-01

    The management of sinonasal and ventral skull base malignancies is best performed by a team. Although the composition of the team may vary, it is important to have multidisciplinary representation. There are multiple obstacles, both individual and institutional, that must be overcome to develop a highly functioning team. Adequate training is an important part of team-building and can be fostered with surgical telementoring. A quality improvement program should be incorporated into the activities of a skull base team. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. The effect of metallothionein 2A core promoter region single-nucleotide polymorphism on accumulation of toxic metals in sinonasal inverted papilloma tissues

    SciTech Connect

    Starska, Katarzyna; Bryś, Magdalena; Forma, Ewa; Lewy-Trenda, Iwona; Danilewicz, Marian; Krześlak, Anna

    2015-06-15

    Metallothioneins (MTs) are intracellular thiol-rich heavy metal-binding proteins which join trace metal ions protecting cells against heavy metal toxicity and regulate metal distribution and donation to various enzymes and transcription factors. The goal of this study was to identify the − 5 A/G (rs28366003) single-nucleotide polymorphism (SNP) in the core promoter region of the MT2A gene, and to investigate its effect on allele-specific gene expression and Cd, Zn, Cu and Ni content in sinonasal inverted papilloma tissue (IP), with non-cancerous sinonasal mucosa (NCM) as a control. The MT2A promoter region − 5 A/G SNP was identified by restriction fragment length polymorphism using 117 IP and 132 NCM. MT2A gene analysis was performed by quantitative real-time PCR. Metal levels were analyzed by flame atomic absorption spectrometry. The frequency of A allele carriage was 99.2% and 100% in IP and NCM, respectively. The G allele carriage was detected in 23.9% of IP and in 12.1% of the NCM samples. As a result, a significant association of − 5 A/G SNP in MT2A gene with mRNA expression in both groups was determined. A significant association was identified between the − 5 A/G SNP in the MT2A gene with mRNA expression in both groups. A highly significant association was detected between the rs28366003 genotype and Cd and Zn content in IP. Furthermore, significant differences were identified between A/A and A/G genotype with regard to the type of metal contaminant. The Spearman rank correlation results showed the MT2A gene expression and both Cd and Cu levels were negatively correlated. The results obtained in this study suggest that the − 5 A/G SNP in the MT2A gene may have an effect on allele-specific gene expression and toxic metal accumulation in sinonasal inverted papilloma. - Highlights: • MT2A gene expression and metal content in sinonasal inverted papilloma tissues • Association between SNP (rs28366003) and expression of MT2A • Significant

  19. Higher antineutrophil cytoplasmic antibody (C-ANCA) titers are associated with increased overall healthcare use in patients with sinonasal manifestations of granulomatosis with polyangiitis (GPA).

    PubMed

    Janisiewicz, Agnieszka M; Klau, Marc H; Keschner, David B; Lehmer, Randy R; Venkat, Kumar V; Medhekar, Swati S; Chang, Parke K; Badran, Karam; Leary, Ryan; Garg, Rohit; Nguyen, Andrew A; Lee, Jivianne T

    2015-01-01

    Granulomatosis with polyangiitis (GPA) is an autoimmune disease characterized by necrotizing granulomatous airway inflammation and vasculitis. Sinonasal involvement occurs in more than 80% cases, with antineutrophil cytoplasmic antibody (C-ANCA) titers used as a marker of disease severity. The purpose of this study was to determine whether C-ANCA levels impact radiographic findings and healthcare use in patients with sinonasal GPA. A retrospective review was performed on GPA patients evaluated in a multidisciplinary rheumatologic/otolaryngologic clinic from 2008 to 2013. Data were collected with respect to age, gender, clinical presentation, C-ANCA titers, Lund-Mackay (LM) scores, surgical interventions, and healthcare use, the latter of which were determined by assessing the number of rheumatology/otolaryngology clinic visits, computed tomography (CT) scans, and email/telephone encounters. A total of 44 patients were identified, 11 male and 33 female. Sinonasal manifestations were evident in 70.4%, with chronic rhinosinusitis (CRS) (41.9%), septal perforation (38.7%), and crusting (32.2%) the most common findings. No significant differences in number of CT scans (p = 0.10) or mean LM scores (p = 0.47) were found between patients with more than or equal to 1:80 and less than 1:80 C-ANCA titers, respectively. However, overall healthcare use was increased in the more than or equal to 1:80 C-ANCA group (n = 28) compared with less than 1:80 (n = 16), with a significantly greater number of rheumatologic/otolaryngologic encounters (mean 121 versus 69.2, p = 0.03) noted. When otolaryngologic healthcare use was specifically examined, the average number of encounters was also higher in more than or equal to 1:80 C-ANCA patients (31.9 versus 22.9), but this difference was not statistically significant (p = 0.16). Sinonasal GPA patients with presenting C-ANCA titers more than or equal to 1:80 demonstrated significantly greater overall healthcare use than their lower C

  20. Sinonasal Quality of Life in Children After Outfracture of Inferior Turbinates and Submucous Inferior Turbinoplasty for Chronic Nasal Congestion.

    PubMed

    Manzi, Brian; Sykes, Kevin J; Wei, Julie L

    2017-05-01

    Chronic nasal congestion often persists in children despite empirical treatment using intranasal corticosteroids, systemic antihistamines, and/or leukotriene receptor antagonists. Symptoms are often reported even with negative results of skin or blood allergy testing. Inferior turbinoplasty has been effective in adults and children, but outfracture of inferior turbinates in children is rarely reported, as is use of validated quality-of-life measures to quantify improvements after intervention. Effective use of these 2 procedures for treating chronic nasal congestion may reduce the need for medication and improve sinonasal quality of life. To quantify changes in sinonasal quality of life for children after outfracture of inferior turbinates and concomitant submucous microdebrider inferior turbinoplasty for chronic nasal congestion. A case series with planned data collection was conducted in an ambulatory pediatric otolaryngology clinic among 43 patients with chronic nasal congestion who underwent surgical intervention between January 1, 2014, and May 31, 2015. Microdebrider submucous inferior turbinoplasty (without bony resection) and outfracture of inferior turbinates. Demographics and medication use before and after the procedure were reviewed. Scores on the Sinus and Nasal Quality of Life Survey (SN-5) and quality-of-life scores were collected at baseline, 4 to 6 weeks after the procedure, and more than 6 months after the procedure. Among the 43 patients (14 girls and 29 boys; mean age, 11.2 years [range, 4.8-17.6 years]), every domain showed significant improvements in scores on the Sinus and Nasal Quality of Life Survey and quality-of-life scores 1 to 2 months after the proecdure: sinus infection (-2.55; 95% CI, 1.85-3.26), nasal obstruction (-3.51; 95% CI, 2.88-4.14), allergy symptoms (-2.14; 95% CI, 1.43-2.86), emotional distress (-2.37; 95% CI, 1.68-3.06), activity limitation (-1.70; 95% CI, 1.14-2.25), and overall quality of life (3.72; 95% CI, 2

  1. Comorbidities in patients with all-positive symptoms on sinonasal outcomes test quality-of-life instrument.

    PubMed

    Caten, Alexander; Johnson, Christopher; Jang, David; Gurrola, Jose; Kountakis, Stilianos

    2015-12-01

    The Sinonasal Outcomes Test-20 (SNOT-20) is a validated tool to assess treatment outcomes in patients with chronic rhinosinusitis (CRS). In the clinic, we observed that patients who responded with a positive score on all 20 items of the SNOT-20 questionnaire (pan-positive patients) often did not have evidence of CRS upon workup. Many of these patients had other underlying diseases contributing to their complaints. Analysis of prospectively collected data was performed to identify SNOT-20 pan-positive patients and compare them to 100 consecutive non-pan-positive patients who served as the control group. The following parameters were compared between the two patient groups: presence or absence of chronic diseases such as obstructive sleep apnea, depression, anxiety, fibromyalgia, chronic pain, headaches, temporomandibular joint disease, and arthritis--in addition to sinus computed-tomography Lund-McKay scores and nasal endoscopy Lund-Kennedy scores. We also reviewed the medication list of each patient to look for the possible presence of mental illness. Statistical analysis was performed using the chi-squared and Student t test. One hundred twenty-two pan-positive patients were identified in our database collected from 2003 to 2011. Pan-positive patients had higher incidence of depression, fibromyalgia, anxiety, pain, headache, and use of depression medications--and they also had higher SNOT-20 and endoscopy scores when compared to controls (P < 0.05). Pan-positive patients were more likely female (P < 0.05), but age and race differences did not reach statistical significance. The SNOT-20 questionnaire assists clinicians to monitor outcomes in patients treated for CRS. However, clinicians should suspect other underlying chronic conditions in SNOT-20 pan-positive patients. 3B. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  2. The 22-item Sino-Nasal Outcome Test accurately reflects patient-reported control of chronic rhinosinusitis symptomatology.

    PubMed

    Gray, Stacey T; Phillips, Katie M; Hoehle, Lloyd P; Caradonna, David S; Sedaghat, Ahmad R

    2017-07-28

    Patient-reported control of chronic rhinosinusitis (CRS) symptoms is associated with the quality of life impact of CRS. We sought to determine if 22-item Sino-Nasal Outcome Test (SNOT-22) score is predictive of patient-perceived CRS symptom control. Prospective cross-sectional study of 202 patients with CRS. Participants were asked to rate their CRS symptom control as "not at all," "a little," "somewhat," "very," and "completely." The severity of patient CRS symptomatology was measured using the SNOT-22. The relationship between SNOT-22 score and patient-reported CRS symptom control was determined using regression, analysis of variance (ANOVA), and receiver operating characteristic (ROC) curve analysis. SNOT-22 was negatively associated with patient-reported CRS symptom control (adjusted β = -0.03; 95% CI, -0.04 to -0.02; p < 0.001), after controlling for demographic and clinical characteristics. There was a significant difference in SNOT-22 scores of participants reporting each level of symptom control (p < 0.001) with the greatest differences between participants who rated their CRS symptom control as "not at all," "a little," and "somewhat," which we deem poor CRS symptom control, and the group who described their level of CRS symptom control described as "very" and "completely," which we deem well-controlled CRS symptoms. These results were true across all SNOT-22 subdomains scores as well. Using ROC analysis, a SNOT-22 score of 35 identified patients reporting poor vs well-controlled CRS symptom control with 71.4% sensitivity and 85.5% specificity. SNOT-22 score is associated with how well patients feel their CRS symptomatology is controlled. Moreover, SNOT-22 score can be used to accurately distinguish patients with poor vs well-controlled CRS symptoms. © 2017 ARS-AAOA, LLC.

  3. Dental flat panel conebeam CT in the evaluation of patients with inflammatory sinonasal disease: Diagnostic efficacy and radiation dose savings.

    PubMed

    Leiva-Salinas, C; Flors, L; Gras, P; Más-Estellés, F; Lemercier, P; Patrie, J T; Wintermark, M; Martí-Bonmatí, L

    2014-01-01

    CT is the imaging modality of choice to study the paranasal sinuses; unfortunately, it involves significant radiation dose. Our aim was to assess the diagnostic validity, image quality, and radiation-dose savings of dental conebeam CT in the evaluation of patients with suspected inflammatory disorders of the paranasal sinuses. We prospectively studied 40 patients with suspected inflammatory disorders of the sinuses with dental conebeam CT and standard CT. Two radiologists analyzed the images independently, blinded to clinical information. The image quality of both techniques and the diagnostic validity of dental conebeam CT compared with the reference standard CT were assessed by using 3 different scoring systems. Image noise, signal-to-noise ratio, and contrast-to-noise ratio were calculated for both techniques. The absorbed radiation dose to the lenses and thyroid and parotid glands was measured by using a phantom and dosimeter chips. The effective radiation dose for CT was calculated. All dental conebeam CT scans were judged of diagnostic quality. Compared with CT, the conebeam CT image noise was 37.3% higher (P < .001) and the SNR of the bone was 75% lower (P < .001). The effective dose of our conebeam CT protocol was 23 μSv. Compared with CT, the absorbed radiation dose to the lenses and parotid and thyroid glands with conebeam CT was 4%, 7.8%, and 7.3% of the dose delivered to the same organs by conventional CT (P < .001). Dental conebeam CT is a valid imaging procedure for the evaluation of patients with inflammatory sinonasal disorders. © 2014 by American Journal of Neuroradiology.

  4. Patterns of Failure After Combined-Modality Approaches Incorporating Radiotherapy for Sinonasal Undifferentiated Carcinoma of the Head and Neck

    SciTech Connect

    Chen, Allen M. Daly, Megan E.; El-Sayed, Ivan; Garcia, Joaquin; Lee, Nancy Y.; Bucci, M. Kara; Kaplan, Michael J.

    2008-02-01

    Purpose: To report the clinical outcome of patients treated with combined-modality approaches for sinonasal undifferentiated carcinoma (SNUC) of the head and neck. Methods and Materials: The records of 21 patients with SNUC treated with curative intent at University of California, San Francisco between 1990 and 2004 were analyzed. Patient age ranged from 33 to 71 years (median, 47 years). Primary tumor sites included the nasal cavity (11 patients), maxillary sinus (5 patients), and ethmoid sinus (5 patients). All patients had T3 (4 patients) or T4 (17 patients) tumors. Local-regional treatment included surgery followed by postoperative radiotherapy (PORT) with or without adjuvant chemotherapy for 17 patients; neoadjuvant chemoradiotherapy followed by surgery for 2 patients; and definitive chemoradiotherapy for 2 patients. Median follow-up among surviving patients was 58 months (range, 12-70 months). Results: The 2- and 5-year estimates of local control were 60% and 56%, respectively. There was no difference in local control according to initial treatment approach, but among the 19 patients who underwent surgery the 5-year local control rate was 74% for those with gross tumor resection, compared with 24% for those with subtotal tumor resection (p = 0.001). The 5-year rates of overall and distant metastasis-free survival were 43% and 64%, respectively. Late complications included cataracts (2 patients), lacrimal stenosis (1 patient), and sino-cutaneous fistula (1 patient). Conclusion: The suboptimal outcomes suggest a need for more effective therapies. Gross total resection should be the goal of all treatments whenever possible.

  5. Sangre de grado Croton palanostigma induces apoptosis in human gastrointestinal cancer cells.

    PubMed

    Sandoval, Manuel; Okuhama, Nataly N; Clark, Melinda; Angeles, Fausto M; Lao, Juan; Bustamante, Sergio; Miller, Mark J S

    2002-05-01

    Sangre de grado is an ethnomedicinal red tree sap obtained from Croton spp. that is used to treat gastrointestinal ulcers, cancer and to promote wound healing. To evaluate the potential role of sangre de grado (SdG) in cancer we examined its effects on human cancer cells, AGS (stomach), HT29 and T84 (colon). Viability of cells treated with SdG (10-200 microg/ml) decreased (P<0.01) in a dose dependent manner measured over a 24-h period. Cell proliferation at 48 h decreased (P<0.01) in all cells treated with SdG (>100 microg/ml). When cells in suspension were treated with SdG (100 microg/ml) cell adherence was severely compromised (>85%). Cells treated with SdG (100 microg/ml) underwent apoptosis as detected by nucleus condensation and DNA fragmentation determined by ELISA, and flow cytometry. Morphological changes as assessed by acridine orange. These effects were similar to that observed with Taxol (30 microM). A significant alteration of microtubular architecture was equally observed in both stomach and colon cancer cells exposed to SdG (100 microg/ml). The induction of apoptosis and microtubule damage in AGS, HT29 and T84 cells suggest that sangre de grado should be evaluated further as a potential source of anti-cancer agents.

  6. The burden of revision sinonasal surgery in the UK—data from the Chronic Rhinosinusitis Epidemiology Study (CRES): a cross-sectional study

    PubMed Central

    Philpott, Carl; Hopkins, Claire; Erskine, Sally; Kumar, Nirmal; Robertson, Alasdair; Farboud, Amir; Ahmed, Shahzada; Anari, Shahram; Cathcart, Russell; Khalil, Hisham; Jervis, Paul; Carrie, Sean; Kara, Naveed; Prinsley, Peter; Almeyda, Robert; Mansell, Nicolas; Sunkaraneni, Sankalp; Salam, Mahmoud; Ray, Jaydip; Panesaar, Jaan; Hobson, Jonathan; Clark, Allan; Morris, Steve

    2015-01-01

    Objectives The aim of this study was to investigate the surgical revision rate in patients with chronic rhinosinusitis (CRS) in the UK CRS Epidemiology Study (CRES). Previous evidence from National Sinonasal Audit showed that 1459 patients with CRS demonstrated a surgical revision rate 19.1% at 5 years, with highest rates seen in those with polyps (20.6%). Setting Thirty secondary care centres around the UK. Participants A total of 221 controls and 1249 patients with CRS were recruited to the study including those with polyps (CRSwNPs), without polyps (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS). Interventions Self-administered questionnaire. Primary outcome measure The need for previous sinonasal surgery. Results A total of 651 patients with CRSwNPs, 553 with CRSsNPs and 45 with AFRS were included. A total of 396 (57%) patients with CRSwNPs/AFRS reported having undergone previous endoscopic nasal polypectomy (ENP), of which 182 of the 396 (46%) reported having received more than one operation. The mean number of previous surgeries per patient in the revision group was 3.3 (range 2–30) and a mean duration of time of 10 years since the last procedure. The average length of time since their first operation up to inclusion in the study was 15.5 years (range 0–74). Only 27.9% of all patients reporting a prior ENP had received concurrent endoscopic sinus surgery (ESS; n=102). For comparison, surgical rates in patients with CRSsNPs were significantly lower; 13% of cases specifically reported ESS, and of those only 30% reported multiple procedures (χ2 p<0.001). Conclusions This study demonstrated that there is a high burden of both primary and revision surgery in patients with CRS, worst in those with AFRS and least in those with CRSsNPs. The burden of revision surgery appears unchanged in the decade since the Sinonasal Audit. PMID:25926143

  7. A Subset of Sinonasal Non-Intestinal Type Adenocarcinomas are Truly Seromucinous Adenocarcinomas: A Morphologic and Immunophenotypic Assessment and Description of a Novel Pitfall.

    PubMed

    Purgina, Bibianna; Bastaki, Jassem M; Duvvuri, Umamaheswar; Seethala, Raja R

    2015-12-01

    While sinonasal intestinal type adenocarcinoma (ITAC) is defined by an intestinal phenotype, non-intestinal type adenocarcinoma (non-ITAC) is traditionally viewed as a diagnosis of exclusion, despite previous implication of a seromucinous phenotype and similarity to sinonasal seromucinous hamartomas (SSH). We performed a comparison of clinicopathologic and immunophenotypic features of ITAC, non-ITAC and SSH using traditional discriminatory markers and new markers of seromucinous differentiation. Twenty-three non-ITAC, 17 ITAC, and 5 SSH were retrieved (1987-2014). As expected, ITAC occurred predominantly in the nasal cavity in elderly patients (mean age 65 years) with a striking male predilection (15:2). Regardless of grade/subtype, all ITAC were invariably CK20 and CDX2 positive, and many (11/15) showed some CK7 positivity. Non-ITAC occurred in younger individuals (mean age 51 years) with a slight female predilection (male to female ratio: 10:13) and showed diverse morphologic patterns and grades, some with morphologic similarity to SSH. SSH occurred in younger individuals (mean age 33 years). Non-ITAC and SSH were invariably CK7 positive and CK20 negative, however, 4/22 non-ITAC and 2/5 SSH showed squamoid morular metaplasia that aberrantly expressed CDX2 and co-expressed nuclear β-catenin. Markers of seromucinous differentiation (S100, DOG1, and SOX10) were essentially absent in ITAC, but present to varying degrees in the majority of non-ITAC and all SSH. Thus, the term 'seromucinous adenocarcinoma' is the more appropriate designation for non-ITAC. Squamoid morules in non-ITAC and SSH may be an immunophenotypic pitfall given the aberrant CDX2 expression.

  8. Pedagogia artistica: la conceptualizacion y la creatividad en estudiantes de ciencias de sexto grado

    NASA Astrophysics Data System (ADS)

    Ortiz Colon, Edwin A.

    Se realizo un estudio fenomenologico sobre la conceptualizacion, la creatividad y el valor del dibujo en propiciar un contexto creativo para el aprendizaje de ciencias de sexto grado. La conceptualizacion se interpreto como un proceso que ocurre en las relaciones que los estudiantes establecen entre los temas de estudio y las ideas principales, las experiencias previas, las creencias personales, el tiempo y el valor de la conservacion ambiental. La esencia de la creatividad se definio en funcion de la imaginacion, las destrezas, la intencion, la libertad de pensamiento y expresion y el contexto. El dibujo propicio un ambiente creativo de aprendizaje en las ciencias al facilitar el uso del pensamiento cientifico profundo, el inquirir artistico y la expresion libre.

  9. Hydraulic zonation of the lagoons of Marano and Grado, Italy. A modelling approach

    NASA Astrophysics Data System (ADS)

    Ferrarin, Christian; Umgiesser, Georg; Bajo, Marco; Bellafiore, Debora; De Pascalis, Francesca; Ghezzo, Michol; Mattassi, Giorgio; Scroccaro, Isabella

    2010-05-01

    The hydraulic regime-based zonation scheme of the Lagoons of Marano and Grado (Italy) has been derived by means of numerical models. A finite element modelling system has been used to describe the water circulation taking in account different forces such as tide, wind and rivers. The model has been validated by comparing the simulation results against measured water levels, salinity and water temperature data collected in several stations inside the lagoons. The analysis of water circulation, salinity and spatial distribution of passive tracers released at the inlets, led to a physically-based division of the lagoons system into six subbasins. The derived classification scheme is of crucial value for understanding the renewal capacity and pollutants distribution patterns in the lagoon.

  10. Patterns of p21waf1/cip1 expression in non-papillomatous nasal mucosa, endophytic sinonasal papillomas, and associated carcinomas

    PubMed Central

    Schwerer, M; Sailer, A; Kraft, K; Baczako, K; Maier, H

    2001-01-01

    Aims—To clarify p21waf1/cip1 expression in sinonasal lesions. Methods—Archived surgical specimens from 38 patients were investigated by means of immunohistochemistry. p21waf1/cip1 staining was evaluated in the different layers of the epithelium. In addition, human papillomavirus (HPV) infection and p53 protein overexpression were assessed and correlated with p21waf1/cip1 expression. Results—p21waf1/cip1 staining was negative in non-papillomatous nasal mucosa. HPV infection and p53 protein overexpression were not seen. Sixteen of 20 inverted papillomas showed p21waf1/cip1 expression. HPV infection was found in 16 cases and p53 protein overexpression was present in 13 specimens. Expression of p21waf1/cip1 was restricted to surface cells in five cases, but involved basal/parabasal cells in 11 specimens. Immunoreactivity for p21waf1/cip1 in basal/parabasal cells colocalised with p53 protein overexpression. Enhanced expression rates for p21waf1/cip1 were seen in transitional and squamous epithelium compared with columnar epithelium. p21waf1/cip1 expression involved only surface cells in cylindrical cell papillomas. HPV infection and p53 protein overexpression were detected in all specimens. One of five squamous cell carcinomas showed p21waf1/cip1 expression. HPV infection was seen in two cases, and all carcinomas showed p53 protein overexpression. Conclusions—Expression of p21waf1/cip1 is associated with terminal differentiation in surface cells in inverted papillomas and cylindrical cell papillomas, but not in non-papillomatous nasal mucosa. Overexpression of p53 protein colocalises with p21waf1/cip1 expression in basal/parabasal cells in inverted papillomas but not in cylindrical cell papillomas. Expression of p21waf1/cip1 in squamous cell carcinomas involves a subset of tumours with p53 protein overexpression. Key Words: p21waf1/cip1 • nasal mucosa • sinonasal papillomas • squamous cell carcinomas PMID:11684723

  11. p53 and BCL-2 over-expression inversely correlates with histological differentiation in occupational ethmoidal intestinal-type sinonasal adenocarcinoma.

    PubMed

    Re, M; Magliulo, G; Tarchini, P; Mallardi, V; Rubini, C; Santarelli, A; Lo Muzio, L

    2011-01-01

    Despite their histological resemblance to colorectal adenocarcinoma, there is little information on the molecular events involved in the pathogenesis of intestinal-type sinonasal adenocarcinoma (ITACs). The aim of this paper is to evaluate the possible role of TP53 and Bcl-2 gene defects in ITAC by investigating the immunohistochemical expression of TP53 and Bcl-2 gene products in a group of ethmoidal ITACs associated with occupational exposure. A retrospective study on 15 patients with pathological diagnosis of primary ethmoidal ITAC was conducted. Representative formalin-fixed, paraffin wax-embedded block from each case was selected for immunohistochemical studies using the antibodies against p53 and Bcl-2. Clinical-pathological data were also correlated with the staining results. The results of immunohistochemical examination demonstrated that poorly differentiated cases showed a higher percentage of p53 and Bcl-2 expressing cells in comparison to well-differentiated cases. No correlation was found with other clinico-pathological parameters, including T, stage and relapses. The relationship between up-regulation of p53 and Bcl-2 and poorly differentiated ethmoidal adenocarcinoma suggests a role of these genes, in combination with additional genetic events, in the pathogenesis of ITAC.

  12. Eosinophils and mast cells: a comparison of nasal mucosa histology and cytology to markers in nasal discharge in patients with chronic sino-nasal diseases.

    PubMed

    Gröger, Moritz; Bernt, Andreas; Wolf, Maria; Mack, Brigitte; Pfrogner, Elisabeth; Becker, Sven; Kramer, Matthias F

    2013-09-01

    Allergic rhinitis (AR), nasal polyps (NP) as well as chronic rhinosinusitis (CRS) are all known to be associated with eosinophilic infiltration and elevated numbers of mast cells (MC) within the mucosa. Both cell types and their markers eosinophilic cationic protein (ECP) and tryptase are utilized in the diagnosis and management of chronic sino-nasal diseases. Mucosal cytology samples were gathered by cytobrush, histological samples were obtained from the inferior turbinate. In both sample sets, the number of eosinophils and MC was determined. Their corresponding markers ECP and tryptase were quantified from nasal discharge. Patients were grouped with reference to their main diagnosis: AR (n = 34), NP (n = 25), CRS (n = 27) and controls (n = 34). Eosinophil counts from cytobrush and ECP levels were significantly elevated in NP compared to all other groups-31- and 13-fold over control, respectively. However, histologic review did not reveal any difference in eosinophil count among groups. Tryptase was significantly elevated threefold in AR versus CRS and controls. No correlation to cytological and histological MC counts could be found. ECP levels in nasal discharge as well as eosinophil counts can provide useful information with regard to the diagnosis. Likewise, tryptase concentrations can do. The presented data show that the measurement of markers in nasal discharge is superior in differentiating among diagnosis groups. Given that the collection of nasal secretions is more comfortable for patients than the more invasive techniques, we recommend first line ECP and tryptase testing performed on nasal secretions.

  13. Seasonal mercury transformation and surficial sediment detoxification by bacteria of Marano and Grado lagoons

    NASA Astrophysics Data System (ADS)

    Baldi, Franco; Gallo, Michele; Marchetto, Davide; Fani, Renato; Maida, Isabel; Horvat, Milena; Fajon, Vesna; Zizek, Suzana; Hines, Mark

    2012-11-01

    Marano and Grado lagoons are polluted by mercury from the Isonzo River and a chlor-alkali plant, yet despite this contamination, clam cultivation is one of the main activities in the region. Four stations (MA, MB, MC and GD) were chosen for clam seeding and surficial sediments were monitored in autumn, winter and summer to determine the Hg detoxifying role of bacteria. Biotransformation of Hg species in surficial sediments of Marano and Grado lagoons was investigated while taking into consideration the speciation of organic matter in the biochemical classes of PRT (proteins), CHO (carbohydrates) and LIP (lipids), water-washed cations and anions, bacterial biomass, Hg-resistant bacteria, some specific microbial activities such as sulfate reduction rates, Hg methylation rates, Hg-demethylation rates, and enzymatic ionic Hg reduction. MeHg in sediments was well correlated with PRT content, whereas total Hg in sediments correlated with numbers of Hg-resistant bacteria. Correlations of the latter with Hg-demethylation rates in autumn and winter suggested a direct role Hg-resistant bacteria in Hg detoxification by producing elemental Hg (Hg0) from ionic Hg and probably also from MeHg. MeHg-demethylation rates were ˜10 times higher than Hg methylation rates, were highest in summer and correlated with high sulfate reduction rates indicating that MeHg was probably degraded in summer by sulfate-reducing bacteria via an oxidative pathway. During the summer period, aerobic heterotrophic Hg-resistant bacteria decreased to <2% compared to 53% in winter. Four Hg-resistant bacterial strains were isolated, two Gram-positive (Staphylococcus and Bacillus) and two Gram-negative (Stenotrophomonas and Pseudomonas). Two were able to produce Hg0, but just one contained a merA gene; while other two strains did not produce Hg0 even though they were able to grow at 5 μg ml of HgCl2. Lagoon sediments support a strong sulfur cycle in summer that controls Hg methylation and demethylation

  14. Hydromorphic to subaqueous soils transitions in the central Grado lagoon (Northern Adriatic Sea, Italy)

    NASA Astrophysics Data System (ADS)

    Vittori Antisari, Livia; De Nobili, Maria; Ferronato, Chiara; Natale, Marco; Pellegrini, Elisa; Vianello, Gilmo

    2016-05-01

    The Grado lagoon is among the largest in the Mediterranean sea and is characterized by salt marshes, where tides influenced the development of a complex micromorphology coupled to a micromosaic of vegetation covers. This study represents the first contribution to the understanding of the main processes governing formation, development and spatial transitions between hydromorphic and subaqueous soils in an Adriatic lagoon ecosystem. Physicochemical characteristics and development of soils were investigated in three salt marshes differing for their proximity to the open sea, textural composition and age of formation. Soils of back barrier salt marshes had A/C profiles and were mostly characterized by a sandy coarse texture that allows rapid drainage and subsurface oxygen exchanges. Soil sequences from the inner salt marsh to its submerged border slope or to a brackish waterhole do not simply represent a hydrosequence, but also reflect erosion/sorting/accumulation processes. The soils in the central part of the lagoon have finer texture and in displayed transition or cambic horizons. Silty clay loam textures and low positions allowed the development of more severe anoxic conditions and accumulation of sulphides. The tide oscillation strongly contributed to formation of redoximorphic features, intensity of anaerobic conditions but also colonization by different plant communities. Discriminant analysis was performed to identify physicochemical properties which discriminate the different soils according to geo-morphological position and prevailing plants. It confirmed that differentiation of plant communities occurred according to distinct morphological and physicochemical soil properties, but also acted as a primary affecting factor of pedogenesis.

  15. Metallothionein 2A core promoter region genetic polymorphism and its impact on the risk, tumor behavior, and recurrences of sinonasal inverted papilloma (Schneiderian papilloma).

    PubMed

    Starska, Katarzyna; Bryś, Magdalena; Forma, Ewa; Olszewski, Jurek; Pietkiewicz, Piotr; Lewy-Trenda, Iwona; Stasikowska-Kanicka, Olga; Danilewicz, Marian; Krześlak, Anna

    2015-11-01

    Inverted papillomas are a unique group of locally aggressive benign epithelial neoplasms in the nasal cavity and paranasal sinuses arising from the Schneiderian mucosa. Metallothioneins are sulfhydryl-rich heavy metal-binding proteins required for metal toxicity protection and regulation of biological mechanisms including proliferation and invasion. The goal of this study was to identify three SNPs at loci -5 A/G (rs28366003) and -209 A/G (rs1610216) in the core promoter region and at locus +838 C/G (rs10636) in 3'UTR region of the MT2A gene with IP risk and with tumor invasiveness according to Krouse staging. Genotyping was performed using the PCR restriction fragment length polymorphism technique in 130 genetically unrelated IP individuals, and 418 randomly selected healthy volunteers. The presence of the rs28366003 SNP was significantly related to the risk of IP within the present population-based case-control study. Compared to homozygous common allele carriers, heterozygosity and homozygosity for the G variant had a significantly increased risk of IP (adjusted odds ratio [OR] = 7.71, 95% confidence interval [CI]: 4.01-14.91, p(dominant) < 0.001). Moreover, risk allele carriers demonstrated higher Krouse stage (pT1 vs. pT2-4) (OR = 19.32; 95% CI, 2.30-173.53; p < 0.0001), diffuse tumor growth (OR = 4.58; 95% CI, 1.70-12.11; p = 0.0008), bone destruction (OR = 4.13; 95% CI, 1.50-11.60; p = 0.003), and higher incidence of tumor recurrences (OR = 5.11; 95% CI, 1.68-15.20; p = 0.001). The findings suggest that MT2A gene variation rs28366003 may be implicated in the etiology of sinonasal inverted papilloma in a Polish population.

  16. Comparison of the value of measurement of serum galactomannan and Aspergillus-specific antibodies in the diagnosis of canine sino-nasal aspergillosis.

    PubMed

    Billen, F; Peeters, D; Peters, I R; Helps, C R; Huynen, P; De Mol, P; Massart, L; Day, M J; Clercx, C

    2009-02-02

    Serology is currently used for the diagnosis of canine sino-nasal aspergillosis (SNA). However, the accuracy of serological testing using commercially available, standardized purified antigen preparations of Aspergillus (CAPurAspAg) has only been poorly documented. The aim of the present study was to assess the diagnostic value of an agar-gel double immunodiffusion (AGDD) test and an anti-Aspergillus IgG ELISA, using CAPurAspAg and the commercially available Platelia test for the detection of serum galactomannan. Sera from 17 dogs with SNA, 18 dogs with a nasal tumour (NT), 11 dogs with lymphoplasmacytic rhinitis (LPR) and 33 control dogs were tested with the 3 methods. AGDD result was positive in 76.5% of dogs with SNA, whereas all sera from dogs with non-fungal nasal disease and control dogs were negative. A positive IgG ELISA result was obtained in 88% of dogs with SNA and in 18% of dogs with LPR. All patients with NT and control dogs had a negative IgG ELISA result. The Platelia test was positive in 24% of dogs with SNA, 11% of dogs with NT, 9% of dogs with LPR and 24% of control dogs. The results of this study suggest that (1) the detection of serum Aspergillus-specific antibodies with AGDD or ELISA, using CAPurAspAg, provides excellent specificity and good sensitivity, (2) the specificity is higher for AGDD (100%) than for ELISA (96.8%) while sensitivity is higher for ELISA (88.2%) than for AGDD (76.5%) and (3) serum galactomannan quantification with the Plateliat test is unreliable for the diagnosis of canine SNA.

  17. Mercury methylation and demethylation in Hg-contaminated lagoon sediments (Marano and Grado Lagoon, Italy)

    NASA Astrophysics Data System (ADS)

    Hines, Mark E.; Poitras, Erin N.; Covelli, Stefano; Faganeli, Jadran; Emili, Andrea; Žižek, Suzana; Horvat, Milena

    2012-11-01

    Mercury (Hg) transformation activities and sulfate (SO42-) reduction were studied in sediments of the Marano and Grado Lagoons in the Northern Adriatic Sea region as part of the "MIRACLE" project. The lagoons, which are sites of clam (Tapes philippinarum) farming, have been receiving excess Hg from the Isonzo River for centuries. Marano Lagoon is also contaminated from a chlor-alkali plant. Radiotracer methods were used to measure mercury methylation (230Hg, 197Hg), methylmercury (MeHg) demethylation (14C-MeHg) and SO42- reduction (35S) in sediment cores collected in autumn, winter and summer. Mercury methylation rate constants ranged from near zero to 0.054 day-1, generally decreased with depth, and were highest in summer. Demethylation rate constants were much higher than methylation reaching values of ˜0.6 day-1 in summer. Demethylation occurred via the oxidative pathway, except in winter when the reductive pathway increased in importance in surficial sediments. Sulfate reduction was also most active in summer (up to 1600 nmol mL-1 day-1) and depth profiles reflected seasonally changing redox conditions near the surface. Methylation and demethylation rate constants correlated positively with SO42- reduction and pore-water Hg concentrations, and inversely with Hg sediment-water partition coefficients indicating the importance of SO42- reduction and Hg dissolution on Hg cycling. Hg transformation rates were calculated using rate constants and concentrations of Hg species. In laboratory experiments, methylation was inhibited by amendments of the SO42--reduction inhibitor molybdate and by nitrate. Lagoon sediments displayed a dynamic seasonal cycle in which Hg dissolution in spring/summer stimulated Hg methylation, which was followed by a net loss of MeHg in autumn from demethylation. Sulfate-reducing bacteria (SRB) tended to be responsible for methylation of Hg and the oxidative demethylation of MeHg. However, during winter in surficial sediments, iron

  18. Investigation of sinonasal anatomy via low-dose multidetector CT examination in chronic rhinosinusitis patients with higher risk for perioperative complications.

    PubMed

    Fraczek, Marcin; Guzinski, Maciej; Morawska-Kochman, Monika; Krecicki, Tomasz

    2017-02-01

    The aim of the study was to compare visualisation of the surgically relevant anatomical structures via low- and standard-dose multidetector CT protocol in patients with chronic rhinosinusitis (CRS) and higher risk for perioperative complications (i.e. presence of bronchial asthma, history of sinus surgery and advanced nasal polyposis). 135 adult CRS patients were divided randomly into standard-dose (120 kVp, 100 mAs) or low-dose CT groups (120 kVp, 45 mAs). The detectability of the vital anatomical structures (anterior ethmoid artery, optic nerve, cribriform plate and lamina papyracea) was scored using a five-point scale (from excellent to unacceptable) by a radiologist and sinus surgeon. Polyp sizes were quantified endoscopically according to the Lildholdt's scale (LS). Olfactory function was tested with the "Sniffin' Sticks" test. On the low-dose CT images, detectability ranged from 2.42 (better than poor) for cribriform plate among anosmic cases to 4.11 (better than good) for lamina papyracea in cases without nasal polyps. Identification of lamina papyracea on low-dose scans was significantly worse in each group and the same was the case with cribriform plates in patients with advanced polyposis and anosmia. Cribriform plates were the most poorly identified (between poor and average) among all the structures on low-dose images. Identification of anterior ethmoid artery (AEA) with reduced dose was insignificantly worse than with standard-dose examination. The AEA was scored as an average-defined structure and was the second weakest visualised. In conclusion, preoperatively, low-dose protocols may not sufficiently visualise the surgically relevant anatomical structures in patients with CRS and bronchial asthma, advanced nasal polyps (LS > 2) and history of sinus surgery. Low mAs value enables comparable detectability of sinonasal landmarks with standard-dose protocols in patients without analysed risk factors. In the context of planned surgery, the current

  19. TU-C-12A-11: Comparisons Between Cu-ATSM PET and DCE-CT Kinetic Parameters in Canine Sinonasal Tumors

    SciTech Connect

    La Fontaine, M; Bradshaw, T; Kubicek, L; Forrest, L; Jeraj, R

    2014-06-15

    Purpose: Regions of poor perfusion within tumors may be associated with higher hypoxic levels. This study aimed to test this hypothesis by comparing measurements of hypoxia from Cu-ATSM PET to vasculature kinetic parameters from DCE-CT kinetic analysis. Methods: Ten canine patients with sinonasal tumors received one Cu-ATSM PET/CT scan and three DCE-CT scans prior to treatment. Cu-ATSM PET/CT and DCE-CT scans were registered and resampled to matching voxel dimensions. Kinetic analysis was performed on DCE-CT scans and for each patient, the resulting kinetic parameter values from the three DCE-CT scans were averaged together. Cu-ATSM SUVs were spatially correlated (r{sub spatial}) on a voxel-to-voxel basis against the following DCE-CT kinetic parameters: transit time (t{sub 1}), blood flow (F), vasculature fraction (v{sub 1}), and permeability (PS). In addition, whole-tumor comparisons were performed by correlating (r{sub ROI}) the mean Cu-ATSM SUV (SUV{sub mean}) with median kinetic parameter values. Results: The spatial correlations (r{sub spatial}) were poor and ranged from -0.04 to 0.21 for all kinetic parameters. These low spatial correlations may be due to high variability in the DCE-CT kinetic parameter voxel values between scans. In our hypothesis, t{sub 1} was expected to have a positive correlation, while F was expected to have a negative correlation to hypoxia. However, in wholetumor analysis the opposite was found for both t{sub 1} (r{sub ROI} = -0.25) and F (r{sub ROI} = 0.56). PS and v{sub 1} may depict angiogenic responses to hypoxia and found positive correlations to Cu-ATSM SUV for PS (r{sub ROI} = 0.41), and v{sub 1} (r{sub ROI} = 0.57). Conclusion: Low spatial correlations were found between Cu-ATSM uptake and DCE-CT vasculature parameters, implying that poor perfusion is not associated with higher hypoxic regions. Across patients, the most hypoxic tumors tended to have higher blood flow values, which is contrary to our initial hypothesis. Funding

  20. A case-case study on sinonasal cancer prevention: effect from dust reduction in woodworking and risk of mastic/solvents in shoemaking.

    PubMed

    Emanuelli, Enzo; Alexandre, Enrico; Cazzador, Diego; Comiati, Vera; Volo, Tiziana; Zanon, Alessia; Scapellato, Maria Luisa; Carrieri, Mariella; Martini, Alessandro; Mastrangelo, Giuseppe

    2016-01-01

    Sinonasal cancers (SNCs) are rare neoplasms, accounting for about 3 % of head and neck cancers, with squamous cell carcinoma (SCC) and adenocarcinoma (ADC) as the most common subtypes. ADCs present strong associations with occupational wood dust exposure. Preventive measures have progressively reduced wood dust concentrations in workplaces but no study has evaluated the effectiveness of such interventions. Few studies indicate associations between ADC and exposure to solvents, which is common in the shoe industry, but this hypothesis still needs confirmation. In a case-case study, we contrasted 32 ADCs against 21 Non-Adenocarcinoma Epithelial Tumors (NAETs) - all recruited from the same clinical setting (Padua's University Hospital; period 2004-2015) - using questionnaires and clinical records to collect information on potential predictors. Non-occupational factors were age, sex, smoking, allergy and chronic sinusitis. Occupational factors were intensity and frequency of wood dust exposure, protection from wood dust, type of wood (in woodworking); frequency of exposure to leather dust or mastic/solvent (in shoemaking). Odds-ratio (OR), 95 % confidence interval (95 % CI) and two-tail p-values were obtained through stepwise backward logistic regression for each industry, always using as reference patients never employed in either trade and adjusting for non-occupational risk factors. Adjusted OR was 22.5 (95 % CI = 3.50-144; p = 0.001) and 9.37 (95 % CI = 1.29-67.6; p = 0.026), respectively, in patients with low or high degree of protection against wood dust. In the shoe industry, adjusted OR was 1 and 18.8 (95 % CI = 1.29-174; p = 0.030), respectively, in patients with low or high exposure to only mastic/solvent; and 1 and 22.5 (95 % CI = 2.07-244; p = 0.011), respectively, in patients with low or high exposure to only leather dust. The questionnaire used was able to estimate with simple algorithms past exposures in wood and

  1. Benthic flux measurements of Hg species in a northern Adriatic lagoon environment (Marano and Grado Lagoon, Italy)

    NASA Astrophysics Data System (ADS)

    Emili, Andrea; Acquavita, Alessandro; Koron, Neža; Covelli, Stefano; Faganeli, Jadran; Horvat, Milena; Žižek, Suzana; Fajon, Vesna

    2012-11-01

    As part of the "MIRACLE" project, the biogeochemical cycling of mercury (Hg) at the sediment-water interface was studied in the field in the Marano and Grado Lagoon (Northern Adriatic Sea). Seasonal investigations were conducted at selected experimental sites, where Manila Clams (Tapes philippinarum) were previously seeded. Measurements were performed seasonally during three campaigns, using two benthic chambers, one transparent and one dark, to evaluate the effect of light on Hg cycling. Total dissolved Hg (THg), methylmercury (MeHg), and dissolved gaseous Hg (DGM) species were considered. Diurnal benthic fluxes were found to significantly exceed the diffusive fluxes at all stations. The assessment of the annual recycling of Hg species from sediments to the water column showed that up to 99% of MeHg is recycled annually to the water column, while Hg recycling ranges from 30 to 60%. MeHg poses the higher risk for potential bioaccumulation in clams, but it is partially mitigated by Hg reduction, which seems to be an important process leading to evasion losses of Hg from these environments. Estimated benthic fluxes suggest that Hg recycling at the sediment-water interface is more active in the Grado sector. Hence, based on the estimated release of MeHg from sediments, it is suggested that the western sector seems to be more suitable for clam farming and the extension of rearing activities.

  2. Effect of abiotic and biotic factors on the abundance of waterbirds in Grado-Marano Lagoon (Italy)

    NASA Astrophysics Data System (ADS)

    Altobelli, Alfredo; Hubina, Tatsiana; Sponza, Stefano; Sisto, Alberto

    2008-10-01

    The purpose of this paper is to assess the influence of several biotic and abiotic factors on the abundance of waterbirds in the Grado-Marano Lagoon. The Grado-Marano Lagoon is situated in the Northeast of the Adriatic Sea with an extension of approximately 160 km2. ASTER satellite images were utilized to classify different types of morphologies and habitat, including sea grass meadows. Four abiotic factors (total nitrogen, total phosphorous, alkalinity and sediment texture) and three biotic factors (benthic community, sea grass meadows and waterbird guild abundance) were integrated into a GIS. A regular UTM grid of square cells (Operational Geographic Units, OGUs), 1km x 1km, was superimposed on the entire lagoon. Using the Hierarchical Cluster Analysis (HCA) technique it was possible to delineate ecological units (clusters of OGUs) and Principal Component Analysis (PCA) was used to reduce the dimensionality of the factors considered. Subsequently, Correspondence Analysis (CA) was used to examine the relationship between waterbird guild abundance and ecological units.

  3. Sinonasal Wegener's granulomatosis: CT characteristics.

    PubMed

    Benoudiba, F; Marsot-Dupuch, K; Rabia, M Hadj; Cabanne, J; Bobin, S; Lasjaunias, P

    2003-02-01

    Wegener's granulomatosis (WG) is a severe and potentially lethal granulomatosis. Even though no specific radiological criteria exist, CT may suggest the correct diagnosis at an early stage. Recent improvement in the prognosis is related to earlier diagnosis, allowing the initiation of efficient and specific treatment before any severe complications occur. We reviewed a series of WG cases in order to establish the CT diagnostic criteria.

  4. Manila clams from Hg polluted sediments of Marano and Grado lagoons (Italy) harbor detoxifying Hg resistant bacteria in soft tissues.

    PubMed

    Baldi, Franco; Gallo, Michele; Marchetto, Davide; Faleri, Claudia; Maida, Isabel; Fani, Renato

    2013-08-01

    A mechanism of mercury detoxification has been suggested by a previous study on Hg bioaccumulation in Manila clams (Ruditapes philippinarum) in the polluted Marano and Grado lagoons and in this study we demonstrate that this event could be partly related to the detoxifying activities of Hg-resistant bacteria (MRB) harbored in clam soft tissues. Therefore, natural clams were collected in six stations during two different periods (winter and spring) from Marano and Grado Lagoons. Siphons, gills and hepatopancreas from acclimatized clams were sterile dissected to isolate MRB. These anatomical parts were glass homogenized or used for whole, and they were lying on a solid medium containing 5mgl(-1) HgCl2 and incubated at 30°C. A total of fourteen bacterial strains were isolated and were identified by 16S rDNA sequencing and analysis, revealing that strains were representative of eight bacterial genera, four of which were Gram-positive (Enterococcus, Bacillus, Jeotgalicoccus and Staphylococcus) and other four were Gram-negative (Stenotrophomonas, Vibrio, Raoultella and Enterobacter). Plasmids and merA genes were found and their sequences determined. Fluorescence in situ hybridization (FISH) technique shows the presence of Firmicutes, Actinobacteria and Gammaproteobacteria by using different molecular probes in siphon and gills. Bacterial clumps inside clam flesh were observed and even a Gram-negative endosymbiont was disclosed by transmission electronic microscope inside clam cells. Bacteria harbored in cavities of soft tissue have mercury detoxifying activity. This feature was confirmed by the determination of mercuric reductase in glass-homogenized siphons and gills. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Manila clams from Hg polluted sediments of Marano and Grado lagoons (Italy) harbor detoxifying Hg resistant bacteria in soft tissues

    SciTech Connect

    Baldi, Franco; Gallo, Michele; Marchetto, Davide; Faleri, Claudia; Maida, Isabel; Fani, Renato

    2013-08-15

    A mechanism of mercury detoxification has been suggested by a previous study on Hg bioaccumulation in Manila clams (Ruditapes philippinarum) in the polluted Marano and Grado lagoons and in this study we demonstrate that this event could be partly related to the detoxifying activities of Hg-resistant bacteria (MRB) harbored in clam soft tissues. Therefore, natural clams were collected in six stations during two different periods (winter and spring) from Marano and Grado Lagoons. Siphons, gills and hepatopancreas from acclimatized clams were sterile dissected to isolate MRB. These anatomical parts were glass homogenized or used for whole, and they were lying on a solid medium containing 5 mg l{sup −1} HgCl{sub 2} and incubated at 30 °C. A total of fourteen bacterial strains were isolated and were identified by 16S rDNA sequencing and analysis, revealing that strains were representative of eight bacterial genera, four of which were Gram-positive (Enterococcus, Bacillus, Jeotgalicoccus and Staphylococcus) and other four were Gram-negative (Stenotrophomonas, Vibrio, Raoultella and Enterobacter). Plasmids and merA genes were found and their sequences determined. Fluorescence in situ hybridization (FISH) technique shows the presence of Firmicutes, Actinobacteria and Gammaproteobacteria by using different molecular probes in siphon and gills. Bacterial clumps inside clam flesh were observed and even a Gram-negative endosymbiont was disclosed by transmission electronic microscope inside clam cells. Bacteria harbored in cavities of soft tissue have mercury detoxifying activity. This feature was confirmed by the determination of mercuric reductase in glass-homogenized siphons and gills. -- Highlights: ► We isolated Gram-positive and Gram-negative Hg resistant strains from soft tissues of Ruditapes philippinarum. ► We identify 14 mercury resistant strains by 16S rRNA gene sequences. ► Bacteria in siphon and gill tissues of clams were observed by TEM and identified

  6. The operational weather radar of Fossalon di Grado (Gorizia, Italy): accuracy of reflectivity and differential reflectivity measurements

    NASA Astrophysics Data System (ADS)

    Bechini, R.; Gorgucci, E.; Scarchilli, G.; Dietrich, S.

    The error structure of radar measurements should be accurately known in order to provide reliable estimates for a number of quantitative meteorological applications, from rainfall rate estimation to cloud microphysics. The aim of this paper is to give a detailed characterization of ZH and ZDR measurements obtained by the weather radar of Fossalon di Grado (Gorizia, Italy). Vertical-looking observations are used to determine the system bias on differential reflectivity and to estimate the measurement error on both ZH and ZDR in the rain medium. It is estimated that no bias is affecting ZDR and the accuracy of ZH and ZDR is 0.8 and 0.1dB, respectively. A similar evaluation is done in the rain medium at larger ranges with the antenna pointing at low elevation angles. The long time stability of the absolute reflectivity calibration is also established by radar-rain gage inter-comparison over almost 200 hours of precipitation data collected during nearly two years.

  7. Mercury in the sediments of the Marano and Grado Lagoon (northern Adriatic Sea): Sources, distribution and speciation

    NASA Astrophysics Data System (ADS)

    Acquavita, Alessandro; Covelli, Stefano; Emili, Andrea; Berto, Daniela; Faganeli, Jadran; Giani, Michele; Horvat, Milena; Koron, Neža; Rampazzo, Federico

    2012-11-01

    The existence of mining tailings in Idrija (Slovenia) and their subsequent transportation via the Isonzo River has been the primary source of mercury (Hg) in the northern Adriatic Sea for almost 500 years, making the Gulf of Trieste and the adjacent Marano and Grado Lagoon two of the most contaminated marine areas in the world. A further, more recent, contribution of Hg has been added by the operation of a chlor-alkali plant (CAP) located in the drainage basin flowing into the Lagoon. On the basis of previous research, as well as new data obtained from the "MIRACLE" project (Mercury Interdisciplinary Research for Appropriate Clam farming in a Lagoon Environment), the spatial distribution of Hg and its relationships with methylmercury (MeHg), organic matter and several geochemical parameters in surface sediments were investigated. The predominant and long-term impacts of the cinnabar-rich Isonzo River particulate matter in the Lagoon surface sediments are evident and confirmed by a decreasing concentration gradient from east (>11 μg g-1) to west (0.7 μg g-1). Hg originated from the CAP is only significant in the central sector of the Lagoon. Hg is primarily associated with fine-grained sediments (<16 μm), as a consequence of transport and dispersion from the fluvial source through littoral and tidal currents. However, speciation analyses highlighted the presence of Hg sulphides in the coarse sandy fraction of sediments from the eastern area, as expected given the origin of the sedimentary material. Unlike Hg, the distribution of MeHg (0.47-7.85 ng g-1) does not show a clear trend. MeHg constitutes, on average, 0.08% of total Hg and percentages are comparable to those obtained in similar lagoon environments. Higher MeHg concentrations in low to intermediate Hg-contaminated sediments indicate that the metal availability is not a limiting factor for MeHg occurrence, thus suggesting a major role played by environmental conditions and/or speciation. The reasonably

  8. Benthic fluxes of oxygen, carbon and nutrients in the Marano and Grado Lagoon (northern Adriatic Sea, Italy)

    NASA Astrophysics Data System (ADS)

    De Vittor, C.; Faganeli, J.; Emili, A.; Covelli, S.; Predonzani, S.; Acquavita, A.

    2012-11-01

    Benthic metabolism and carbon and nutrient cycling at the sediment-water interface were studied seasonally in the Marano (sites MB and MC) and Grado Lagoon (sites ART and BAR), northern Adriatic Italy, using porewater vertical profiles and daily fluxes of O2, DIC, DOC, NO3-, NH4+, PO43- and SiO44- measured in situ deployed transparent and dark benthic chambers. Diffusive and benthic fluxes of solutes were evaluated on a seasonal basis. Sites MC and ART were characterized by higher Corg. contents due to input of riverine organic matter and mariculture, respectively. The Corg., Ntot., Ptot., Porg. and Sibiog. contents decreased along the sediment cores while porewater concentrations of DIC, DOC, NO3-, NH4+, PO43- and SiO44- increased along the sediment cores at all study sites due to the degradation of labile sedimentary matter. Higher concentrations of all porewater solutes and higher diffusive fluxes were observed in warmer periods. Benthic fluxes of O2, DIC, NO3-, NH4+, PO43- and SiO44- showed intensive seasonal variations. Based on O2 and DIC metabolism, the lagoon sediments were highly heterotrophic except at BAR being in trophic balance or weakly heterotrophic. NO3- and SiO44- exhibited influxes due to intense microphytobenthic assimilation, mostly by diatoms, and denitrification while extremely low PO43- fluxes suggest P as a limiting factor. The great difference observed between the diffusive and the in situ benthic fluxes suggests the importance of bioturbation and that the pertinent processes occur at the sediment-water interface. Tentative annual budgets of carbon and nutrients in surface sediments of studied sites indicate that their cycling, compared to burial flux, is more intensive at the sediment-water interface. These basic benthic biogeochemical processes can be important to better understand the trace metal cycling, especially Hg mobilization and sequestration, in the lagoon environment.

  9. Historical flux of mercury associated with mining and industrial sources in the Marano and Grado Lagoon (northern Adriatic Sea)

    NASA Astrophysics Data System (ADS)

    Covelli, Stefano; Langone, Leonardo; Acquavita, Alessandro; Piani, Raffaella; Emili, Andrea

    2012-11-01

    The "MIRACLE" Project was established in order to assess the feasibility of clam farming and high levels of sediment mercury (Hg) contamination coexisting in the Marano and Grado Lagoon, Italy. This lagoon has been subjected to Hg input from both industrial waste (chlor-alkali plant) and long-term mining activity (Idrija mine, NW Slovenia). One of the subtasks of the "MIRACLE" Project was to determine the historical evolution of Hg accumulation in the lagoon's bottom sediments. Thirteen 1-m deep sediment cores were collected from the subtidal and intertidal zones, plus one in a saltmarsh, all of which were then analyzed for total Hg content and several physicochemical parameters. Sedimentation rate assessments were performed by measuring short-lived radionuclides (excess 210Pb and 137Cs). For most of the analyzed cores, natural background levels of Hg were observed at depths of 50-100 cm. In the eastern area, Hg contamination was found to be at its maximum level at the core top (up to 12 μg g-1) as a consequence of the long-term mining activity. The vertical distribution of Hg was related to the influence of the single-point contamination sources, whereas the grain-size variability or organic matter content seemed not to affect it. In the western area, Hg content at the surface was found not to exceed 7 μg g-1 and contamination was recorded only in the first 20-30 cm. Geochronological measurements showed that the depositional flux of Hg was influenced by anthropogenic inputs after 1800, when mining activity was more intense. After 1950, Hg in the surface sediment, most remarkable in the central-western sector, seemed to also be affected by the discharge of the Aussa River, which delivers Hg from the chlor-alkali plant. In 1996, Hg mining at Idrija ceased, however the core profiles did not show any subsequent decreasing trend in terms of Hg flux, which implies the system retaining some "memory" of contamination. Thus, in the short term, a decrease in Hg inputs

  10. Human impact and the historical transformation of saltmarshes in the Marano and Grado Lagoon, northern Adriatic Sea

    NASA Astrophysics Data System (ADS)

    Fontolan, Giorgio; Pillon, Simone; Bezzi, Annelore; Villalta, Renato; Lipizer, Marco; Triches, Antonella; D'Aietti, Alessandro

    2012-11-01

    Historical transformations of the saltmarshes in the six sub-basins of the Marano and Grado Lagoon were analyzed using aerial photographs (1954, 1990, 2006), and the support of historical maps and topographic surveys. Analysis of the 2006 set of aerial photographs enabled the definition of the present extent and distribution of the saltmarshes inside the lagoon (760 ha), with a total reduction in saltmarsh area of 16% (144 ha) compared to 1954. Direct human actions played a significant role in the budget, since total loss due to land reclamation and dredging during this period amounted to 126 ha. After excluding the total loss due to direct human interventions, different erosional and depositional marsh types were recognized and associated with different forcing factors, based on morphological and geographical evidence. Over the 52-year period marshes were lost due to: (a) drowning - the combined effects of eustatism, regional subsidence and autocompaction (102 ha); (b) edge-retreat by wind wave attack (34 ha); (c) erosion by vessel-generated waves (37 ha); and (d) coastal dynamics and inlet migration (5.7 ha). Conversely, marshes gained in area due to: (a) fluvial input (63 ha); (b) tidal input (27 ha); (c) paralagoonal deposition (45 ha); (d) the re-opening of abandoned fish farms (18 ha); and (e) the dumping of dredged material (8 ha). Our analysis demonstrates that local and short-term forcing factors can obliterate or compensate the long-term ones, especially the relative sea-level rise. A test of the integrated sediment budget carried out on one third of the total lagoon, through a bathymetric comparison between datasets from 1964 to 2009, pointed out that conservation or slight expansion of the marshes inside these basins were linked to an overall positive sediment budget of 61,000 m3/y. Nevertheless, significant morphological changes occurred in the submerged basin, which is affected by sustained deposition along the inner margins due to sediment supplies

  11. Establishing utility values for the 22-item Sino-Nasal Outcome Test (SNOT-22) using a crosswalk to the EuroQol-five-dimensional questionnaire-three-level version (EQ-5D-3L).

    PubMed

    Crump, R Trafford; Lai, Ernest; Liu, Guiping; Janjua, Arif; Sutherland, Jason M

    2017-05-01

    Chronic rhinosinusitis (CRS) is a common condition for which there are numerous medical and surgical treatments. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a patient-reported outcome measure often used with patients diagnosed with CRS. However, there are no utility values associated with the SNOT-22, limiting its use in comparative effectiveness research. The purpose of this study was to establish utilities for the SNOT-22 by mapping responses to utility values associated with the EuroQol-5-dimensional questionnaire-3-level version (EQ-5D-3L). This study used data collected from patients diagnosed with CRS awaiting bilateral endoscopic sinus surgery in Vancouver, Canada. Study participants completed both the SNOT-22 and the EQ-5D-3L. Ordinary least squares was used for 3 models that estimated the EQ-5D-3L utility values as a function of the SNOT-22 items. A total of 232 participants completed both the SNOT-22 and the EQ-5D-3L. As expected, there was a negative relationship between the SNOT-22 global scores and EQ-5D-3L utility values. Adjusted R(2) for the 3 models ranged from 0.28 to 0.33, and root mean squared errors between 0.23 and 0.24. A nonparametric bootstrap analysis demonstrated robustness of the findings. This study successfully developed a mapping model to associate utility values with responses to the SNOT-22. This model could be used to conduct comparative effectiveness research in CRS to evaluate the various interventions available for treating this condition. © 2017 ARS-AAOA, LLC.

  12. Review of antiviral and immunomodulating properties of plants of the Peruvian rainforest with a particular emphasis on Una de Gato and Sangre de Grado.

    PubMed

    Williams, J E

    2001-12-01

    Viral diseases, including emerging and chronic viruses, are an increasing worldwide health concern. As a consequence, the discovery of new antiviral agents from plants has assumed more urgency than in the past. A number of native Amazonian medicines of plant origin are known to have antimicrobial and anti-inflammatory activity, although only a few have been studied for their antiviral properties and immunomodulating effects. Those most studied include: Sangre de Grado (drago) (Croton lechleri) in the Euphorbiaceae family and Una de Gato (Uncaria tomentosa) in the Rubiaceae family. This article reviews the chemical composition, pharmacological properties, state of current research, clinical use, and potential antiviral and immunomodulating activity of these and other plants from the Peruvian Amazon.

  13. Management and treatment of sinonasal inverted papilloma

    PubMed Central

    Ungari, Claudio; Riccardi, Emiliano; Reale, Gabriele; Agrillo, Alessandro; Rinna, Claudio; Mitro, Valeria; Filiaci, Fabio

    2015-01-01

    Summary Aims The aim of this paper is to describe the surgical experience of 35 patients with Inverted Papilloma (IP) of paranasal sinuses and its recurrence rate after a year of follow-up. Materials A retrospective chart review was performed on patients presenting with IP of paranasal sinuses. Thirty-five patients comprised the focus of this study. For all patients was performed a pre-surgery TC, and for more 5 patients it was necessary to perform a Magnetic Resonance (MR) with gadolinium. Results Among 35 patients selected, 18 patients underwent to open surgery, 4 patients had a combined approach with endoscopy and open surgery, while 13 patients were managed only with an endoscopic approach, with a minimum of 1 year of follow-up. Our results highlighted that the global percentage of success 12 months after the treatment was 93% and it not vary according to the tipology of the approach used if a radical excision of the lesion is achieved. More in depth, among 35 cases, only 2 patients were found to have recurrences and were treated with coronal and endoscopic approach. Conclusion It is fundamental to underline that surgery must be carried on in a radical manner to treat these tend to recur. A complete removal of the lesion and bone peripheral border filing are essential to perform a correct and definitive treatment. Also, endoscopic approach can be taken into account when tumors are localized median to a sagittal plan crossing the orbit median wall and when they did not massively compromised paranasal sinus walls. PMID:26941894

  14. Sinonasal disorders in hematopoietic stem cell transplantation.

    PubMed

    Bento, Lucas Ricci; Ortiz, Erica; Nicola, Ester Maria Danieli; Vigorito, Afonso C; Sakano, Eulalia

    2014-01-01

    hematopoietic stem cell transplantation (HSCT) is associated with more respiratory infections due to immunosuppression. this study aimed to verify the frequency of rhinosinusitis after HSCT, and the association between rhinosinusitis and chronic graft vs. host disease (GVHD) and type of transplantation, clinical treatment, surgical treatment, and survival. this was a retrospective study in a tertiary university hospital. A total of 95 patients with hematological diseases undergoing HSCT between 1996 and 2011 were selected. chronic myeloid leukemia was the most prevalent disease. The type of transplant most often performed was the allogenic type (85.26%). The frequency of rhinosinusitis was 36%, with no difference between the autologous and the allogenic types. Chronic GVHD occurred in 30% of patients. Patients with GVHD had a higher frequency and recurrence of rhinosinusitis, in addition to more frequent need for endoscopic sinusectomy and decreased overall survival. there was a higher frequency of rhinosinusitis in HSCT and GVHD. The type of transplant does not appear to predispose to the occurrence of rhinosinusitis. GVHD seems to be an aggravating factor and requires a more stringent treatment. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  15. Modeling Study of the Marano and Grado Lagoon (Italy) to Support the Regional Water Protection Plan) TO SUPPORT THE REGIONAL WATER PROTECTION PLAN

    NASA Astrophysics Data System (ADS)

    Scroccaro, Isabella; Mattassi, Giorgio

    2014-05-01

    The Water Framework Directive 2000/60/EC (WFD) contemplates the classification of water bodies and establishes the quality objectives of water bodies to achieve a good status within 2015. Further, the Italian law which takes in the WFD with Decree n. 152/2006, allows to identify some water bodies as heavily modified (HMWB). The Regional Administration, involved in the setting up of the Water Protection Plan, according with the above mentioned decree and directive, has to establish specific programs to maintain or conform water quality to the requested quality objectives, also for heavily modified water bodies that have to reach the ecological potential. In the north-eastern part of Italy, in the Friuli Venezia Giulia Region, the Marano and Grado Lagoon is the most complex transitional ecosystem in which four water bodies have been temporarily classified as heavily modified. They are identified as FM1, FM2, FM3 and FM4. In particular, FM2 - "Paludo della Carogna" and FM3 - "Barbana" water bodies seem to be characterized by some confinement since they are delimited by a bridge, called "Ponte Belvedere". The preliminary evaluation of the quality status of FM2 and FM3 water bodies is conditioned by the value of one of the quality criteria: the macrophytes. In fact, macrophytes are represented by very few species in these two water bodies. In a preliminary way the overall judgement of FM2 and FM3 water bodies has been indicated by the experts as scarse. This means that a specific programme of measures has to be proposed to improve the quality status of these water bodies in order to reach the ecological potential. In this context modeling may be used as a scientific and technical tool to support the evaluation on FM2 and FM3 water bodies and the effectiveness of specific measures for the achievement of the quality objectives. Numerical simulations of the Marano and Grado lagoon were performed for hydrodynamic circulation, temperature and salinity behavior with the

  16. The effects of resuspension on the fate of Hg in contaminated sediments (Marano and Grado Lagoon, Italy): Short-term simulation experiments

    NASA Astrophysics Data System (ADS)

    Acquavita, Alessandro; Emili, Andrea; Covelli, Stefano; Faganeli, Jadran; Predonzani, Sergio; Koron, Neža; Carrasco, Luis

    2012-11-01

    Sediments of the Marano and Grado Lagoon (Adriatic Sea, Italy) represent one of the world's most major repositories of mercury (Hg). Its presence is a direct consequence of the historical mining activity in nearby Idrjia (Slovenia), as well as significant discharges from a chlor-alkali plant into the Aussa-Corno river system, which connects to the lagoon. Previous studies have shown that sediment acts as secondary source of Hg species to the overlying water column in natural conditions. However, evidence for the effects of resuspension on the dynamics of Hg species is still lacking. The work reported in this paper formed part of the multidisciplinary "MIRACLE" project, aimed at identifying areas at low risk of Hg bioaccumulation in commercial Manila Clams, an important part of the local economy in this region. The effect of resuspension on the cycling of inorganic mercury (IHg), reactive mercury (RHg) and methylmercury (MeHg) between the sediment and water column was investigated in a mesocosm study. Two experiments were conducted in October 2009 and September 2010 based on material collected from sites heavily impacted by Hg and periodically subjected to dredging activities. Designed to mimic the resuspension of particles, both experiments revealed that the release of Hg species from the solid to the dissolved phase became negligible quickly after the event. MeHg values did not change according to total mercury (THg), suggesting that the enhancement of methylation processes may occur. The findings reported in this paper may be useful for the local management of dredging and fishing activities, although mass balance calculations showed that the total flux of Hg species are trivial compared to lagoon-wide processes.

  17. Taste Receptors Mediate Sinonasal Immunity and Respiratory Disease

    PubMed Central

    Douglas, Jennifer E.; Cohen, Noam A.

    2017-01-01

    The bitter taste receptor T2R38 has been shown to play a role in the pathogenesis of chronic rhinosinusitis (CRS), where the receptor functions to enhance upper respiratory innate immunity through a triad of beneficial immune responses. Individuals with a functional version of T2R38 are tasters for the bitter compound phenylthiocarbamide (PTC) and exhibit an anti-microbial response in the upper airway to certain invading pathogens, while those individuals with a non-functional version of the receptor are PTC non-tasters and lack this beneficial response. The clinical ramifications are significant, with the non-taster genotype being an independent risk factor for CRS requiring surgery, poor quality-of-life (QOL) improvements post-operatively, and decreased rhinologic QOL in patients with cystic fibrosis. Furthermore, indirect evidence suggests that non-tasters also have a larger burden of biofilm formation. This new data may influence the clinical management of patients with infectious conditions affecting the upper respiratory tract and possibly at other mucosal sites throughout the body. PMID:28218655

  18. Endoscopic Management of Vascular Sinonasal Tumors, Including Angiofibroma.

    PubMed

    Snyderman, Carl H; Pant, Harshita

    2016-06-01

    The greatest challenge in the surgical treatment of angiofibromas is dealing with the hypervascularity of these tumors. Staging systems that take into account the vascularity of the tumor may be more prognostic. A variety of treatment strategies are used to deal with the vascularity of angiofibromas, including preoperative embolization, segmentation of the tumor into vascular territories, use of hemostatic tools, and staging of surgery. Even large angiofibromas with intracranial extension and residual vascularity can be successfully managed by a skull base team using endoscopic techniques. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Primary Ewing's Sarcoma of the Sinonasal Tract: A Case Report

    PubMed Central

    Suzuki, Tomoharu; Yasumatsu, Ryuji; Nakashima, Torahiko; Arita, Shuji; Yamamoto, Hidetaka; Nakagawa, Takashi

    2017-01-01

    A 23-year-old male presented with a 3-month history of left purulent rhinorrhea, progressive nasal obstruction, and intermittent epistaxis. A fiberoptic examination revealed a large vascular polypoid mass completely filling the left nasal cavity. CT and MRI scans showed a large hypervascular mass involving the left nasal airway, maxillary antrum, and the anterior ethmoid cells. There was no bony erosion or contiguous spread, and the remaining sinuses, orbit, and cranial fossa were uninvolved. The patient underwent complete removal of the mass via an external lateral rhinotomy approach. The soft mass was large and vascular. A microscopic analysis revealed an undifferentiated tumor consisting of a solid sheet of small, round blue cells. Mitotic figures were also present. Immunohistochemically, the tumor cells were strongly positive for CD99. Molecular studies using a PCR confirmed the chromosomal translocation of FLI1 (exon 6). These findings were considered diagnostic for Ewing's sarcoma. Postoperatively, the patient was treated with combined chemotherapy and radiotherapy. Adjuvant chemotherapy consisting of vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide (total: 7 cycles) was commenced. He also received radiation therapy for local control (total dose: 50.4 Gy). The patient is currently alive without any evidence of recurrence or metastasis. PMID:28203170

  20. Oncocytic Schneiderian Papilloma of the Sinonasal Tract Treated With Radiotherapy.

    PubMed

    Kang, Ju Wan; Kim, Young Suk; Kim, Jeong Hong; Kim, Gwi Eon

    2016-01-01

    A 66-year-old man visited the ophthalmology department due to epiphora and was subsequently diagnosed with oncocytic schneiderian papilloma. Surgical removal was recommended to the patient; however, he refused this option. Therefore, a radiation of 64 gray (Gy) was administered in 32 daily doses (2 Gy daily) over 45 days using intensity-modulated radiotherapy. Four months after radiotherapy, the tumor had disappeared. Two years postradiotherapy, the patient was healthy, without tumor recurrence or the development of orbital complications. The authors suggest that radiotherapy could be an adjuvant or definite treatment modality for patients of oncocytic schneiderian papilloma unsuitable for complete surgical removal, or those associated with a high risk of surgery-related complications.

  1. Taste Receptors Mediate Sinonasal Immunity and Respiratory Disease.

    PubMed

    Douglas, Jennifer E; Cohen, Noam A

    2017-02-17

    The bitter taste receptor T2R38 has been shown to play a role in the pathogenesis of chronic rhinosinusitis (CRS), where the receptor functions to enhance upper respiratory innate immunity through a triad of beneficial immune responses. Individuals with a functional version of T2R38 are tasters for the bitter compound phenylthiocarbamide (PTC) and exhibit an anti-microbial response in the upper airway to certain invading pathogens, while those individuals with a non-functional version of the receptor are PTC non-tasters and lack this beneficial response. The clinical ramifications are significant, with the non-taster genotype being an independent risk factor for CRS requiring surgery, poor quality-of-life (QOL) improvements post-operatively, and decreased rhinologic QOL in patients with cystic fibrosis. Furthermore, indirect evidence suggests that non-tasters also have a larger burden of biofilm formation. This new data may influence the clinical management of patients with infectious conditions affecting the upper respiratory tract and possibly at other mucosal sites throughout the body.

  2. Diagnostic Consideration for Sinonasal Wegener's Granulomatosis Clinically Mistaken for Carcinoma

    PubMed Central

    La Rosa, Cristina; Emmanuele, Carmela; Tranchina, Maria Grazia; Ippolito, Massimo; Cosentino, Sebastiano; Saita, Vincenzo; Fraggetta, Filippo

    2013-01-01

    We report a case of Wegener's granulomatosis clinically mistaken for carcinoma in a 21-year-old girl presenting with an ulcerated mass of the nasopharynx associated with enlarged laterocervical nodes. The lesion was clinically suspected as malignant on the basis of clinical and radiological findings (namely, computed tomography scan and positron emission tomography). However, multiple biopsies were not conclusive for malignancy showing histological change suggestive of Wegener's granulomatosis. A serum determination of cANCA supported the diagnosis of Wegener's granulomatosis. Clinical findings and image studies suggested an erroneous diagnosis of malignancy whereas a definitive diagnosis of Wegener's granulomatosis was achieved only after repeated biopsies thus leading to a correct therapeutic approach. The Wegener granulomatosis must be added to the list of the differential diagnoses of the masses of the nasopharynx associated with or without enlarged laterocervical nodes. PMID:24106630

  3. Sinonasal Phosphaturic Mesenchymal Tumor: A Rare and Misinterpreted Entity

    PubMed Central

    Arnaoutakis, Demetri; Naseri, Iman

    2015-01-01

    Objectives Oncogenic osteomalacia is a paraneoplastic syndrome in which the tumor secretes a peptide-like hormone, fibroblast growth factor, resulting in urinary loss of phosphates. Methods We present the case of a 50-year-old woman with a benign phosphaturic mesenchymal tumor (PMT) involving the ethmoid sinus with obstruction of the ostiomeatal complex causing unilateral nasal airway obstruction. Results The tumor was initially thought to be an esthesioneuroblastoma based on primary pathology interpretation and on clinical and radiographic appearance. However, a benign PMT was later confirmed by further testing. Conclusion The tumor was removed entirely by the endoscopic transnasal approach, leading to a full resolution of symptoms. PMID:26623233

  4. RENAL CELL CARCINOMA METASTASIS TO THE SINONASAL CAVITY: CASE REPORT.

    PubMed

    Kovačić, Marijan; Krvavica, Ana; Rudić, Milan

    2015-06-01

    Renal cell carcinoma accounts for 3% of all adult malignant tumors. Common sites of metastases are lungs, bone, liver, brain and adrenal glands. Metastatic disease to the head and neck ranges from 15% to 30%. The 5-year survival rate after nephrectomy is 60%-75%, but with multiorgan metastases the 5-year survival rate is significantly lower, 0-7%. A case is presented of a female patient diagnosed with renal cell carcinoma metastases to the paranasal sinuses, diagnosed and treated at the Department of ENT and Head and Neck Surgery, Zadar General Hospital, Zadar, Croatia. The tumor was surgically removed. Unfortunately, the patient died one year after the procedure due to multiorgan failure. Although metastases of renal cell carcinoma to the head and neck are very rare, it should be first suspected when investigating a metastatic tumor in this region. Surgical excision offers the best hope for long term survival. In case of unresectable tumor, other treatment options should be considered such as radiotherapy, immunotherapy and chemotherapy.

  5. Benign sinonasal masses: a clinicopathological and radiological profile.

    PubMed

    Nepal, A; Chettri, S T; Joshi, J J; Karki, S

    2013-01-01

    Benign nasal and paranasal sinus masses are commonly encountered in clinical practice. Though benign, certain nasal polyps, fungal sinusitis, hemangiomas and fibro-osseous tumors can present with locally destructive features and deformities, mimicking malignancies at once. This study was carried out to recognize the great variety of benign nasal lesions and their frequency in our region. A retrospective chart analysis of cases presenting as mass in nose and paranasal sinus that underwent surgery over three years duration at our institute was done. A provisional diagnosis was made after clinical assessment and radiological investigations, but the final diagnosis was established after histopathological examination. A total 331 cases presented as masses in nose and paranasal sinus presented during the period. The clinicopathological examination aided by endoscopic and imaging studies revealed the non neoplastic benign masses in 293 and neoplastic masses in 38. Polyps were the commonest lesions constituting 70% cases followed by rhinosporidiosis in 10%. Fungal sinusitis, squamous papillomas, hemangiomas and inverted papillomas were found to be in order of 4.5%, 4%, 3.5% and 3% respectively. Rare cases like "rhinooto- cereberal" form of mucormycosis, angiomyoma, and psammomatoid ossifying fibroma were also observed in the study. Most of the nasal polyps/fungal sinusitis can be diagnosed clinically. However many a times Computer tomography (CT) scan and biopsy are necessary to differentiate them from each other and treatment plan. Certain benign tumors have high potential for malignant transformation while others can present with locally destructive features and deformities.

  6. El rol de Ia colaboracion y el Modelo de Aprendizaje Basado en Proyectos (ABPr) mediante el lente de la Teoria de Actividad (CHAT): un estudio de caso con estudiantes de 9no grado

    NASA Astrophysics Data System (ADS)

    Delgado, Isabel C.

    Los modelos de eensenanza y aprendizaje constructivistas conceptualizan el aprendizaje como un proceso activo. El modelo de Aprendizaje Basado en Proyectos (ABPr) se distingue por una serie de componentes, entre los cuales se destaca el aspecto colaborativo y cooperativo como un reto al momento de su implantacion. Son pocas las investigaciones que se concentran en este aspecto del modelo. En este estudio, se analizaron las diversas interacciones que surgen durante la implantacion de una unidad curricular sobre el tema de Geologia de Puerto Rico, la cual se diseno con el modelo ABPr cuyo enfoque es orientacion a proyectos. Particularmente, se examinaron las interacciones sociales que surgen entre los pares y entre pares y docente durante el proceso de planificacion y desarrollo de los productos finales, al igual que las interacciones entre los estudiantes y el material didactico en estas etapas del modelo. La investigacion es de tipo cualitativo e incorpora como diseno el estudio de caso. Las diversas interacciones constituyen la unidad de analisis. En el estudio participaron 19 estudiantes de 9no grado, a quienes se organizaron en 5 grupos colaborativos por temas de interes (Pangea, Placas tectonicas, Volcanes, Tsunamis y Terremotos). Las tecnicas que se utilizaron para recopilar los datos fueron: observaciones participativas, grupos focales y analisis de documentos (cuadernos reflexivos y respuestas de los estudiantes a la pregunta central del proyecto). Para el analisis de los datos se aplico la teoria de actividad (CHAT) que concentra la unidad de analisis en la actividad humana en un contexto particular. Los resultados del estudio senalan que las interacciones entre pares, entre pares y docente, asi como entre estudiantes y material didactico son fundamentales en el proceso de aprendizaje. Una mayor interaccion entre pares durante las etapas de planificar y desarrollar los productos finales de la unidad, promueve una mejor comprension de los conceptos de la

  7. [Endoscopic salvage treatment for optic neuropathy caused by sinonasal fibro-osseous lesions].

    PubMed

    Deng, J; Chen, F H; Lai, Y Y; Shi, J B

    2017-09-07

    Objective: To summarize the surgical techniques, benefits and limitations of transnasal endoscopic resection and optic nerve decompression for patients with optic neuropathy caused by fibro-osseous lesions. Methods: Eight patients with optic neuropathy caused by fibro-osseous lesions who accepted endoscopic surgery of either resection of the lesion or decompression of optic nerve in Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University from 2007 to 2016 were retrospectively reviewed and followed until April, 2017. Analyses were performed on the pathology type, disease extent and disease duration, especially on the visual acuity and visual field changes before and after surgery. Results: Eight patients (5 male and 3 female) were included in this study, with a median age of 12 years old (8-19 years old). The median disease duration was 12 months (1-72 months). The visual acuity (VA) of five patients (40 cm/FC, 0.2, 0.1, 0.2, 10 cm/FC, respectively) improved after surgery (0.1, 0.3, 1.2, 0.1, 0.6, respectively), and one patient had no change of VA after the surgery. Two patients (0.02, hand movement, before surgery) became deprived of light perception (VA=0) immediately after surgery. One patient complicated with intra orbital hemorrhage because of anterior artery injury. No complications of cerebral spinal fluid leak, intra-ocular muscle injury, intra-cranial hemorrhage or brain tissue injury occurred. Conclusion: For the treatment of optic neuropathy caused by fibro-osseous lesions, transnasal endoscopic surgery might have a good outcome.

  8. Smell Decline as a good Predictor of Sinonasal Polyposis Recurrence after Endoscopic Surgery

    PubMed Central

    Bakhshaee, Mahdi; Sharifian, Mohammad Reza; Ghazizadeh, Amir Hossain; Nahid, Kianoosh; Jalaeian Samani, Karim

    2016-01-01

    Introduction: To evaluate the most sensitive symptom to predict early recurrence of nasal polyposis. Prospective longitudinal cohort study. Tertiary university referral center with accredited otorhinolaryngology residency programs. Materials and Methods: In this prospective study, we evaluated 62 patients with diffuse nasal polyposis. All patients underwent functional endoscopic sinus surgery. The author-devised questionnaire relating to the four major symptoms of chronic rhinosinusitis were answered by patients at the pre-operative visit and at 1, 3, 6, 12, and 24 months after surgery. Patients were followed up with serial endoscopic examinations, and a computed tomography (CT) scan was performed if indicated.  Results: All 62 patients (37 male, 25 female) completed the study. The mean age was 41.24 ± 12.47 years. All major symptoms showed significant improvement after surgery (P=0.000); however, the severity of symptoms gradually increased in patients with a recurrence of polyposis, but at different points in time (P= 0.008). Sense of smell was the first symptom to deteriorate in patients with relapse (mean, 6 months) followed by nasal secretion (12 months), obstruction and pain(24 months). Patients with asthma, Samter’s triad, allergic fungal rhinosinusitis (AFRS) and allergic rhinitis showed symptoms of recurrence sooner than other patients (P<0.05).  Conclusion: The most sensitive symptom for the early detection of recurrence of nasal polyposis is a decrease in the sense of smell. Nasal obstruction and facial pain were observed in the late stage of relapse when frank polyposis formation was established. PMID:27280099

  9. Quality of life factors and survival after total or extended maxillectomy for sinonasal malignancies.

    PubMed

    Murphy, James; Isaiah, Amal; Wolf, Jeffrey S; Lubek, Joshua E

    2015-04-01

    Total and extended maxillectomy results in significant morbidity that can have an effect on quality of life factors. Modern reconstructive techniques have ameliorated this effect, but they have not been quantified. The purpose of the present study was to evaluate the quality of life factors and survival of patients undergoing total or extended maxillectomy for malignant disease. A retrospective study was performed of all patients who had undergone total or extended maxillectomy at a tertiary care cancer center from January 2008 to May 2013. The minimum follow-up period was 6 months. The quality of life factors analyzed included swallowing function and diet consistency, pain control, and postoperative complications. A total of 25 patients (13 women and 12 men) met the inclusion criteria. Using the American Joint Committee on Cancer staging system, 76% of the patients had stage IV disease. Of the 25 patients, 13 received a free tissue transfer, 11 an obturator flap, and 1 a regional flap. None of the patients with a free tissue transfer experienced failure. The tumor size had no systemic influence on the reconstructive method chosen (P = .32 to P = .98). The median follow-up period was 41 weeks (range 24 to 252). One death was recorded, and 10 patients were lost to follow-up. Eleven patients progressed to a regular diet. Fifteen patients required a tracheostomy, and all were decannulated at a mean of 14 days postoperatively. One patient had dental implants placed. The type of reconstruction did not influence swallowing function (P = .49) or long-term pain (P = .38). The mean pain score was 4.9 ± 2.7. Pain management proved difficult in 7 patients. Also, 6 patients developed a surgical site infection, 3 of whom required a return to the operating room. Seven patients were readmitted to the hospital for complications; however, the reconstructive method did not influence the incidence of complications (P = .64). The inevitable morbidity, with respect to quality of life factors, that result from the disfiguring effects of total or extended maxillectomy can be deemed acceptable by patients. We recommend discussing all reconstructive options regarding the management of late-stage maxillary malignancies and the potential effect they can have on patients' quality of life. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Magnetic nanoparticles: a new tool for antibiotic delivery to sinonasal tissues. Results of preliminary studies.

    PubMed

    Dobretsov, K; Stolyar, S; Lopatin, A

    2015-04-01

    Herein we examined the toxicity, penetration properties and ability of Fe2O3·nH2O magnetic nanoparticles extracted from silt of the Borovoye Lake (Krasnoyarsk, Russia) to bind an antibiotic. Experimental studies were carried out using magnetic nanoparticles alone and after antibiotic exposure in tissue samples from nasal mucosa, cartilage and bone (in vitro). Toxicity of particles was studied in laboratory animals (in vivo). Tissues removed at endonasal surgery (nasal mucosa, cartilage and bone of the nasal septum) were placed in solution containing nanoparticles and exposed to a magnetic field. Distribution of nanoparticles was determined by Perls' reaction. After intravenous injection, possible toxic effects of injected nanoparticles on the organs and tissues of rats were evaluated by histological examination. Binding between the nanoparticles and antibiotic (amoxicillin clavulanate) was studied using infrared spectroscopy. In 30 in vitro experiments, magnetisation of Fe2O3·nH2O nanoparticles resulted in their diffuse infiltration into the mucosa, cartilage and bone tissue of the nose and paranasal sinuses. Intravenous injection of 0.2 ml of magnetic nanoparticles into the rat's tail vein did not result in any changes in parenchymatous organs, and the nanoparticles were completely eliminated from the body within 24 hours. The interaction of nanoparticles with amoxicillin clavulanate was demonstrated by infrared spectroscopy. Positive results of experimental studies provide a basis for further clinical investigations of these magnetic nanoparticles and their use in otorhinolaryngology.

  11. The prevalence of human papillomavirus infection in Iranian patients with sinonasal inverted papilloma.

    PubMed

    Jalilvand, Somayeh; Saidi, Masoumeh; Shoja, Zabihollah; Ghavami, Nastaran; Hamkar, Rasool

    2016-03-01

    Inverted papilloma (IP) is an uncommon disease which arises in the mucosal membrane of the nasal cavity and paranasal sinus. It has been proposed that human papillomavirus (HPV) is the causal agent in the pathogenesis of IP and plays a key role in the progression from benign IP to malignancy. As there are no prior studies that focus on an Iranian population, this study intended to characterize the prevalence of HPV types in benign and malignant forms of IP. In this retrospective study, we included a total of 40 IP patients [37 benign IP and 3 IP/squamous cell carcinoma (SCC)] who were referred to Amiralam Hospital in Tehran from 2004-2006. HPV was detected in 18.9% and 100% of IP and IP/SCC cases, respectively. In all HPV positive cases of IP and IP/SCC cases, HPV6/11 and HPV16/18 were detected, respectively. Therefore, HPV types were different between the IP and IP/SCC patients, and this difference was statistically significant (p = 0.002). This study suggests that HPV6 and 11 may be involved in the development of IP, but HPV16 and 18 likely play an important role in the progression from benign to malignant form of IP. Copyright © 2015. Published by Elsevier Taiwan LLC.

  12. Aerodynamic characteristics inside the rhino-sinonasal cavity after functional endoscopic sinus surgery.

    PubMed

    Chen, Xiao Bing; Lee, Heow Pueh; Chong, Vincent Fook Hin; Wang, De Yun

    2011-01-01

    The aim of this study was to evaluate effects of functional endoscopic sinus surgery (FESS) on transient nasal aerodynamic flow patterns using computational fluid dynamics (CFD) simulations. A three-dimensional model of the nasal cavity was constructed from CT scans of a patient with FESS interventions on the right side of the nasal cavity. CFD simulations were then performed for unsteady aerodynamic flow modeling inside the nasal cavity as well as the sinuses. Comparisons of the local velocity magnitude and streamline distributions inside the left and right nasal cavity and maxillary sinus regions were presented. Because of the FESS procedures in the right nasal cavity, existences and distributions of local circulations (vortexes) were found to be significantly different for the same nasal airflow rate but at different acceleration, deceleration, or quiet phases in the maxillary sinus region on the FESS side. Because of inertia effects, local internal airflow with circulation existences was continuous throughout the whole respiration cycle. With a larger peak inspiration flow rate, the airflow intensity inside the enlarged maxillary sinus increased significantly. Possible outcomes on functional performances of the nose were also examined and discussed. Surgical enlargements of natural ostium of the maxillary sinus will change the aerodynamic patterns inside the main nasal cavity and maxillary sinus regions, which may affect normal nasal physiological functions. Local inertia effects play more important roles for the internal nasal airflow pattern changes and thus such conventional FESS procedures should be carefully planned.

  13. Smell Decline as a good Predictor of Sinonasal Polyposis Recurrence after Endoscopic Surgery.

    PubMed

    Bakhshaee, Mahdi; Sharifian, Mohammad Reza; Ghazizadeh, Amir Hossain; Nahid, Kianoosh; Jalaeian Samani, Karim

    2016-03-01

    To evaluate the most sensitive symptom to predict early recurrence of nasal polyposis. Prospective longitudinal cohort study. Tertiary university referral center with accredited otorhinolaryngology residency programs. In this prospective study, we evaluated 62 patients with diffuse nasal polyposis. All patients underwent functional endoscopic sinus surgery. The author-devised questionnaire relating to the four major symptoms of chronic rhinosinusitis were answered by patients at the pre-operative visit and at 1, 3, 6, 12, and 24 months after surgery. Patients were followed up with serial endoscopic examinations, and a computed tomography (CT) scan was performed if indicated. All 62 patients (37 male, 25 female) completed the study. The mean age was 41.24 ± 12.47 years. All major symptoms showed significant improvement after surgery (P=0.000); however, the severity of symptoms gradually increased in patients with a recurrence of polyposis, but at different points in time (P= 0.008). Sense of smell was the first symptom to deteriorate in patients with relapse (mean, 6 months) followed by nasal secretion (12 months), obstruction and pain(24 months). Patients with asthma, Samter's triad, allergic fungal rhinosinusitis (AFRS) and allergic rhinitis showed symptoms of recurrence sooner than other patients (P<0.05). The most sensitive symptom for the early detection of recurrence of nasal polyposis is a decrease in the sense of smell. Nasal obstruction and facial pain were observed in the late stage of relapse when frank polyposis formation was established.

  14. [Undifferentiated high grade pleomorphic sarcoma/ malignant fibrous histiocytoma associated a gouty tophus. a case report].

    PubMed

    Szlabi, Susana; Flores, Jorge O; Diller, Ana L de; Cabrera, Marta

    2012-01-01

    Antecedentes: La gota es una enfermedad metabólica por depósito de cristales de ácido úrico, que compromete articulaciones y tejidos blandos tanto en sus etapas agudas como crónicas. Constituye un suceso poco común la aparición de un tumor en el sitio propio de la lesión. Objetivo: presentar un caso de asociación infrecuente entre tofo gotoso y sarcoma. Material y métodos: hombre de 83 años que consultó por tumoración en codo izquierdo de aproximadamente 40 años de evolución, que comenzó a doler espontáneamente. Con la presunción diagnóstica de tofo gotoso se trató quirúrgicamente. La lesión recidivó a los 60 días, se realizó reintervención y radioterapia por diagnóstico de tumor mesenquimal maligno asociado a tofo gotoso. A los 10 meses desarrolló metástasis ganglionar homolateral, falleció antes de los 2 años de la consulta inicial. Resultados: El diagnóstico de la primer biopsia fue tofo gotoso. En el material de reintervención se diagnosticó tofo gotoso asociado a neoplasia mesenquimal fusocelular de alto grado; la inmunohistoquímica reveló: vimentina +/+, MYO D1 -/-, ASMA -/-, FVIII -/-, A1ATT -/-, CD68-/-, S100-/- con resultado diagnóstico final de sarcoma pleomórfico indiferenciado de alto grado. Conclusión: Es infrecuente que los tofos gotosos se asocien a otras enfermedades y menos que lo hagan a tumores. En la bibliografía se han reportado tres casos previos concurrentes con neoplasias, las cuales fueron angiosarcoma, tumor de células gigantes y fibrohistiocitoma maligno. Estos últimos tienen una alta tendencia a recidivar y poseen capacidad de dar metástasis, especialmente a pulmones y ganglios regionales. Palabras clave: tofo gotoso, fibrohistiocitoma maligno, sarcoma pleomórfico indiferenciado.

  15. [Sinonasal cystic adenoid carcinoma with epiphora and orbital involvement. Report of a case and review of the literature].

    PubMed

    Pino Rivero, V; González Palomino, A; Pantoja Hernández, C G; Marcos García, M; Trinidad Ruiz, G; Pardo Romero, G; Blasco Huelva, A

    2005-01-01

    We report the clinical case of a 41 years old male with nasal obstruction of 1 year, epistaxis and epiphora. The ENT exam showed a bleeding red mass in left nasal fossa and CT joint to IRM revealed a tumoral process on that level and informed about its extension to adyacents structures (cavum, ethmoides, sphenoids and maxillary sinus). The biopsy was positive for cystic adenoid carcinoma. Our patient was operated by paralateronasal rhinotomy with removal of the tumor. One year later we found recurrence on the left orbital floor and maxilar sinus. The Oncology Department informed that it was not possible a treatment with radiotherapy or chemotherapy because the low sensitivity of that lesion those treatment.

  16. Geografia de America Latina. Grados Seis-Diez (Geography of Latin America. Grades Six-Ten).

    ERIC Educational Resources Information Center

    Stanford Univ., CA. Stanford Program on International and Cross Cultural Education.

    This publication, intended for Spanish-speaking students in grades 6-10, has three main objectives. First, it serves as an introduction (or refresher) to basic geographic concepts. Second, it is an examination of the physical and political geography of Latin America. Third, it is designed to help students examine maps in a critical manner. The…

  17. Ninos del Arco Iris: Primar Grado = Children of the Rainbow: First Grade.

    ERIC Educational Resources Information Center

    New York City Board of Education, NY.

    This manual for first grade teachers provides suggestions and teaching materials that reflect the multicultural composition of New York City's (New York) public schools. It is organized into two sections: the first is in English, and the second is in Spanish. The English section contains the following six sections: (1) "Planning for the First…

  18. Geografia de America Latina. Grados Seis-Diez (Geography of Latin America. Grades Six-Ten).

    ERIC Educational Resources Information Center

    Stanford Univ., CA. Stanford Program on International and Cross Cultural Education.

    This publication, intended for Spanish-speaking students in grades 6-10, has three main objectives. First, it serves as an introduction (or refresher) to basic geographic concepts. Second, it is an examination of the physical and political geography of Latin America. Third, it is designed to help students examine maps in a critical manner. The…

  19. Segundo Paso. Grados 1ro - 3ro (Second Step. Grades 1-3).

    ERIC Educational Resources Information Center

    Beland, Kathy

    This document is the Spanish language supplement to "Second Step, Grades 1-3," a violence-prevention curriculum designed to reduce impulsive and aggressive behavior in young children and to increase their social competence. The supplement cannot be used by itself, as only a portion of the entire curriculum has been translated into…

  20. Segundo Paso. Grados 4to - 5to (Second Step. Grades 4-5).

    ERIC Educational Resources Information Center

    Beland, Kathy

    This document is the Spanish language supplement to "Second Step, Grades 4-5," a violence-prevention curriculum designed to reduce impulsive and aggressive behavior in young children and to increase their social competence. The supplement, which cannot be used alone, translates portions of the curriculum, such as stories and discussions,…

  1. Prueba de Ciencia Primer Grado (Science Test for the First Grade). [In Spanish

    ERIC Educational Resources Information Center

    Puerto Rico State Dept. of Education, Hato Rey.

    This document consists of three parts: (1) a manual for administering the science test to first graders (in Spanish), (2) a copy of the test itself (pictorial), and (3) a list of expected competencies in science for the first three grades (in English). The test consists of 25, four-choice items. For each item, the administrator reads a statement…

  2. Cytological features of NUT midline carcinoma arising in sino-nasal tract and parotid gland: Report of two new cases and review of the literature.

    PubMed

    Klijanienko, Jerzy; Le Tourneau, Christophe; Rodriguez, José; Caly, Martial; Theocharis, Stamatios

    2016-09-01

    Nuclear Protein in Testis (NUT) Midline Carcinoma (NMC) represents a recently described, uncommon, high-grade and extremely lethal malignancy mainly occurring in children and young adults. Such tumors are genetically characterized by chromosomal rearrangements of the NUT gene. Cytological description of NUT carcinoma is limited and only seven cases were reported up to date. We show here another two cases studied cytologically with molecular and immunohistochemical confirmation. In both cases smears were hypercellular and composed of isolated or clustered small to medium-sized in size with roundish and oval shape cells. Nuclei were either regular or roundish containing dusty chromatin and prominent nucleoli. Mitotic figures were prominent. Cytoplasm was scant, strongly basophilic. Cell debris, necrosis, and apoptosis were also prominent. One of the cases was studied by FISH and the second case was studied by RT-PCR and BRD4-NUT translocation was found in both cases. Moreover, the clinical evolution was aggressive in both cases with rapid fatal clinical outcome. NUT carcinomas are an underdiagnosed entity which should be taken into consideration when poorly differentiated carcinomas was diagnosed in children or young adults. Cytology material may be successfully used for morphological and molecular diagnosis. Diagn. Cytopathol. 2016;44:753-756. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  3. Ossifying inverted papilloma and ossifying polyp of the sinonasal tract: comparison of CT and MRI features.

    PubMed

    Yang, B T; Wang, Y Z; Sun, F R; Dong, J Y

    2017-01-01

    To investigate the key imaging points in distinguishing ossifying inverted papilloma (IP) from polyps. The native computed tomography (CT), conventional and enhanced MRI manifestations of 20 ossifying IPs and eight polyps, which were confirmed histopathologically, were retrospectively evaluated by two doctors majoring in head and neck imaging. A significant difference was detected between the two entities for the involved sites (p<0.05). Although two lesions had similar CT findings, the MRI features differed significantly (p<0.05). Twenty ossifying IPs demonstrated heterogeneously isointense with moderate gadolinium enhancement, and a convoluted "cerebriform" configuration. Seven ossifying polyps revealed low T1 and high T2 signal, with marginal enhancement, and one showed isointense with moderate enhancement. The ossification appeared as oval or striped bone-like high attenuation, which consisted of peripheral hyperattenuating cortical bone and central fat-like attenuation of the medullary cavity. The corresponding MRI findings of the ossifying regions were peripherally low signal and centrally high signal on both T1- and T2-weighted images. The occurrence of two key MRI features of cystic appearance and the "cerebriform" sign were significantly different between two entities (p<0.05). CT can better detect intralesional ossification, but MRI is the optimal imaging technique for discriminating between two disease entities. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  4. A novel BRD4-NUT fusion in an undifferentiated sinonasal tumor highlights alternative splicing as a contributing oncogenic factor in NUT midline carcinoma

    PubMed Central

    Stirnweiss, A; McCarthy, K; Oommen, J; Crook, M L; Hardy, K; Kees, U R; Wilton, S D; Anazodo, A; Beesley, A H

    2015-01-01

    NUT midline carcinoma (NMC) is a fatal cancer that arises in various tissues along the upper midline of the body. The defining molecular feature of NMC is a chromosomal translocation that joins (in the majority of cases) the nuclear testis gene NUT (NUTM1) to the bromodomain protein family member 4 (BRD4) and thereby creating a fusion oncogene that disrupts cellular differentiation and drives the disease. In this study, we report the case of an adolescent NMC patient presenting with severe facial pain, proptosis and visual impairment due to a mass arising from the ethmoid sinus that invaded the right orbit and frontal lobe. Treatment involved radical resection, including exenteration of the affected eye with the view to consolidate treatment with radiation therapy; however, the patient experienced rapid tumor progression and passed away 79 days post resection. Molecular analysis of the tumor tissue identified a novel in-frame BRD4-NUT transcript, with BRD4 exon 15 fused to the last 124 nucleotides of NUT exon 2 (BRD4-NUT ex15:ex2Δnt1–585). The partial deletion of NUT exon 2 was attributed to a mid-exonic genomic breakpoint and the subsequent activation of a cryptic splice site further downstream within the exon. Inhibition of the canonical 3′ acceptor splice site of NUT intron 1 in cell lines expressing the most common NMC fusion transcripts (PER-403, BRD4-NUT ex11:ex2; PER-624, BRD4-NUT ex15:ex2) induced alternative splicing from the same cryptic splice site as identified in the patient. Detection of low levels of an in-frame BRD4-NUT ex11:ex2Δnt1–585 transcript in PER-403 confirmed endogenous splicing from this alternative exon 2 splice site. Although further studies are necessary to assess the clinical relevance of the increasing number of variant fusions described in NMC, the findings presented in this case identify alternative splicing as a mechanism that contributes to this pathogenic complexity. PMID:26551281

  5. Apparent Motion of the Sun, Shadows of Objects and Measurement of Time in the View of Seventh Grade Students of Middle School. (Breton Title: Movimento Aparente do Sol, Sombras dos Objetos e Medição do Tempo na Visão de Alunos do Sétimo Ano do Ensino Fundamental.) Movimiento Aparente del Sol, Sombras de los Objetos y Medición del Tiempo en la Visión de Estudiantes del Séptimo Grado del Ciclo Pirmario

    NASA Astrophysics Data System (ADS)

    Iria Machado, Daniel

    2013-07-01

    analemático, conduzida por um monitor. Uma proporção significativa de estudantes desconhecia inicialmente a maioria dos fenômenos tratados. A intervenção realizada colaborou para uma parte dos alunos assimilar novos conceitos, propiciando o contato com novos fenômenos e, em menor grau, a elaboração de explicações a respeito destes, indicando um potencial educativo dessa ação. Porém, a contribuição para o entendimento de algumas das ideias exploradas foi pequena, apontando para a necessidade de se fazer observações, estudos e discussões complementares. El movimiento aparente del Sol en la esfera celeste y el comportamiento de las sombras de los objetos a lo largo del tiempo son fenómenos observables en la vida cotidiana. Sin embargo, los estudiantes a menudo no tienen una adecuada comprensión de dichos problemas, e incluso pueden mostrar conceptos erróneos acerca de ellos. Por lo tanto, se realizó una investigación a fin de conocer las nociones de los estudiantes acerca de estas cuestiones y evaluar la contribución a su comprensión proporcionada por una actividad realizada con un reloj de Sol interactivo, en un entorno informal de aprendizaje. Se investigaron las ideas de 43 estudiantes del séptimo grado del ciclo primario mediante la aplicación de un test con preguntas abiertas antes y después de una actividad con un reloj de Sol analemático, dirigida por un monitor. Una proporción significativa de los estudiantes inicialmente desconocía la mayoría de los fenómenos tratados. La intervención realizada contribuyó para que los estudiantes asimilasen nuevos conceptos, proporcionando el contacto con nuevos fenómenos y, en menor medida, desarrollasen explicaciones acerca de estos, lo que indica un potencial educativo de esta acción. Sin embargo, la contribución a la comprensión de algunas de las ideas exploradas fue pequeña, lo que apunta a la necesidad de hacer observaciones, estudios y debates adicionales.

  6. Prevenir y Combatir El Acoso en La Escuela: Guia de Recursoso para Educadores de los Grados "K" al Grado "12" (Preventing and Countering School-Based Harassment: A Resource Guide for K-12 Educators).

    ERIC Educational Resources Information Center

    Steineger, Melissa

    This guide focuses on the issue of school-based harassment. It is intended to help educators prevent or curtail all forms of harassment by highlighting school-based harassment issues, by describing remedies and prevention strategies, and by providing additional resources. It details some of the problems school-based harassment engenders, and it…

  7. Aprender haciendo; Manual del Maestro (1 and 6 Grados) (Learning as You Go Along: Teacher's Handbook) (First to Sixth Grades).

    ERIC Educational Resources Information Center

    Secretaria de Educacion Publica (Mexico).

    This document is an English-language abstract (approximately 1,500 words) of six teachers manuals from the first to the sixth grade as used in the Mexican school system. They include suggestions for exercises from folding, cutting out, pasting, coloring and similar operations designed for the first grade up to simple electrical and electronic…

  8. International Symposium on Rarefied Gas Dynamics, 15th, Grado, Italy, June 16-20, 1986, Proceedings. Volumes 1 & 2

    NASA Astrophysics Data System (ADS)

    Boffi, Vinicio; Cercignani, Carlo

    Various papers on rarefied gas dynamics are presented. The general topics addressed include: kinetic theory, mathematical aspects of kinetic theory, analysis of rarefied gas flows, polyatomic gases, Monte Carlo simulation and numerical analysis, vehicle aerodynamics and external flows, gas-surface phenomena, and beams.

  9. Aprender haciendo; Manual del Maestro (1 and 6 Grados) (Learning as You Go Along: Teacher's Handbook) (First to Sixth Grades).

    ERIC Educational Resources Information Center

    Secretaria de Educacion Publica (Mexico).

    This document is an English-language abstract (approximately 1,500 words) of six teachers manuals from the first to the sixth grade as used in the Mexican school system. They include suggestions for exercises from folding, cutting out, pasting, coloring and similar operations designed for the first grade up to simple electrical and electronic…

  10. Distribución espacial de órbitas con diferentes grados de caoticidad en modelos autoconsistentes de satélites galácticos

    NASA Astrophysics Data System (ADS)

    Muzzio, J. C.; Mosquera, M.

    En trabajos anteriores (Carpintero et al., Cel. Mech. Dynam. Astron. 85, 247, 2003), mostramos que las órbitas caóticas son muy importantes en los satélites galácticos. Sin embargo, los únicos modelos autoconsistentes de los que se disponía para ellos eran los de Heggie-Ramamani, cuya función de distribución depende sólo de la energía por lo que no mostraban diferencias entre las distribuciones de sus órbitas regulares y caóticas. Ahora, mediante una aproximación cuadrupolar, hemos logrado construir modelos autoconsistentes de satélites galácticos con distribuciones de velocidades anisotrópicas (lo que indica que sus funciones de distribución no dependen sólo de la energía) y hemos logrado revelar las diferencias entre las estructuras espaciales de las órbitas de distinta caoticidad.

  11. Las Matematicas: Lenguaje Universal. Grados Intermedios, Niveles 1-3. Teacher's Guide I (Mathematics: A Universal Language. Intermediate Grades, Level 1-3. Teacher's Guide I).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This guide covers the first part of a bilingual, sequential mathematics course. The course integrates culturally relevant situations and illustrations with mathematics to reinforce the student's self-concept and encourage cultural pride. This program may be used as a self-contained continuum, as a supplement to another course of study, for…

  12. Las Matematicas: Lenguaje Universal. Grados Intermedios, Niveles 4-6. Teacher's Guide II (Mathematics: A Universal Language. Intermediate Grades, Levels 4-6. Teacher's Guide II).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This guide covers the second part of a bilingual, sequential mathematics course. The course integrates culturally relevant situations and illustrations with mathematics to reinforce the student's self-concept and encourage cultural pride. This program may be used as a self-contained continuum, as a supplement to another course of study, for…

  13. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 5b: Medida Lineal, Perimetro y Area (Mathematics: A Universal Language. Intermediate Grades, Level 5b: Linear Measure, Perimeter and Area).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in this booklet include measurement, perimeter, and area. (MK)

  14. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 6b: Resta de Fracciones (Mathematics: A Universal Language. Intermediate Grades, Level 6b: Subtraction of Fractions).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in this booklet include subtraction of fractions and mixed numbers. (MK)

  15. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 5a: Geometria - Conjuntos de Puntos (Mathematics: A Universal Language. Intermediate Grades, Level 5a: Geometry - Sets of Points).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in the booklet include points, lines, planes, space, angles, and intersection and union of sets. (MK)

  16. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 4a: Multiplicacion de Fracciones (Mathematics: A Universal Language. Intermediate Grades, Level 4a: Multiplication of Fractions).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in this booklet include equivalent fractions, mixed numbers, and multiplication of fractions and mixed numbers. (MK)

  17. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 4b: Division de Fracciones (Mathematics: A Universal Language. Intermediate Grades, Level 4b: Division of Fractions).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in this booklet include reciprocals, complex fractions, and division of fractions. (MK)

  18. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 6a: Suma de Fracciones (Mathematics: A Universal Language. Intermediate Grades, Level 6a: Addition of Fractions).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in this booklet include addition of fractions and mixed numbers. (MK)

  19. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 5a: Geometria - Conjuntos de Puntos (Mathematics: A Universal Language. Intermediate Grades, Level 5a: Geometry - Sets of Points).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in the booklet include points, lines, planes, space, angles, and intersection and union of sets. (MK)

  20. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 4b: Division de Fracciones (Mathematics: A Universal Language. Intermediate Grades, Level 4b: Division of Fractions).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in this booklet include reciprocals, complex fractions, and division of fractions. (MK)

  1. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 6b: Resta de Fracciones (Mathematics: A Universal Language. Intermediate Grades, Level 6b: Subtraction of Fractions).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in this booklet include subtraction of fractions and mixed numbers. (MK)

  2. Las Matematicas: Lenguaje Universal. Grados Intermedios, Niveles 4-6. Teacher's Guide II (Mathematics: A Universal Language. Intermediate Grades, Levels 4-6. Teacher's Guide II).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This guide covers the second part of a bilingual, sequential mathematics course. The course integrates culturally relevant situations and illustrations with mathematics to reinforce the student's self-concept and encourage cultural pride. This program may be used as a self-contained continuum, as a supplement to another course of study, for…

  3. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 5b: Medida Lineal, Perimetro y Area (Mathematics: A Universal Language. Intermediate Grades, Level 5b: Linear Measure, Perimeter and Area).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in this booklet include measurement, perimeter, and area. (MK)

  4. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 4a: Multiplicacion de Fracciones (Mathematics: A Universal Language. Intermediate Grades, Level 4a: Multiplication of Fractions).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in this booklet include equivalent fractions, mixed numbers, and multiplication of fractions and mixed numbers. (MK)

  5. Las Matematicas: Lenguaje Universal. Grados Intermedios, Niveles 1-3. Teacher's Guide I (Mathematics: A Universal Language. Intermediate Grades, Level 1-3. Teacher's Guide I).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This guide covers the first part of a bilingual, sequential mathematics course. The course integrates culturally relevant situations and illustrations with mathematics to reinforce the student's self-concept and encourage cultural pride. This program may be used as a self-contained continuum, as a supplement to another course of study, for…

  6. Las Matematicas: Lenguaje Universal. Grados Intermedios, Nivel 6a: Suma de Fracciones (Mathematics: A Universal Language. Intermediate Grades, Level 6a: Addition of Fractions).

    ERIC Educational Resources Information Center

    Dissemination and Assessment Center for Bilingual Education, Austin, TX.

    This is one of a series of student booklets designed for use in a bilingual mathematics program in grades 6-8. The general format is to present each page in both Spanish and English. The mathematical topics in this booklet include addition of fractions and mixed numbers. (MK)

  7. Las normas de desempeno matematico desde el preescolar hasta el segundo grado (Mathematics Standards for Pre-Kindergarten through Grade 2). ERIC Digest.

    ERIC Educational Resources Information Center

    Richardson, Kathy

    The National Council of Teachers of Mathematics recently published "Principles and Standards for School Mathematics." For the first time, these new standards include pre-kindergarten standards, while outlining the mathematics that children should learn as they progress through school. The standards present a broad view of what…

  8. Odontogenic maxillary sinusitis obscured by midfacial trauma.

    PubMed

    Simuntis, Regimantas; Kubilius, Ričardas; Ryškienė, Silvija; Vaitkus, Saulius

    2015-01-01

    We present a case of odontogenic maxillary sinusitis whose sinonasal symptomatology was thought to be the consequence of a previous midfacial trauma. The patient was admitted to the Clinic of Oral and Maxillofacial Surgery after more than 10 years of exacerbations of sinonasal symptoms, which began to plague soon after a facial contusion. We decided to perform CT of paranasal sinuses, and despite the absence dental symptomatology, the dental origin of sinusitis was discovered. The majority of sinonasal symptoms resolved after appropriate dental treatment, and there was no need for nasal or sinus surgery.

  9. Pembrolizumab Combined With Cetuximab for Treatment of Recurrent/Metastatic Head & Neck Squamous Cell Carcinoma

    ClinicalTrials.gov

    2017-03-28

    HNSCC; Lip SCC; Oral Cavity Cancer; Oropharynx Cancer; Larynx Cancer; Hypopharynx Cancer; Nasopharynx Cancer; Sinonasal Carcinoma; Cutaneous Squamous Cell Carcinoma; Head and Neck Neoplasms; Head and Neck Cancer; Head and Neck Squamous Cell Carcinoma

  10. Schneiderian papilloma of the temporal bone.

    PubMed

    van der Putten, Lisa; Bloemena, Elisabeth; Merkus, Paul; Hensen, Erik F

    2013-12-05

    Temporal bone Schneiderian papilloma may present as a primary tumour originating from the middle ear and mastoid process, or an extension from sinonasal disease. Both forms are rare, this being only the 18th case of primary temporal bone Schneiderian papilloma described to date. Although the current patient has remained disease free after excision of the papilloma, the reported recurrence rate is high, comparable to sinonasal Schneiderian papilloma with extrasinus extension. Malignant progression of primary Schneiderian papillomas is significantly reduced as compared to Schneiderian papillomas that extend from the sinonasal tract into the temporal bone. A positive human papilloma virus status, as found in this case, is a common feature and prognostic factor of sinonasal Schneiderian papilloma but an infrequent finding in temporal bone disease. Owing to the high recurrence rate, the risk of malignant progression and the absence of reliable prognostic markers, stringent follow-up consisting of otoscopy, nasendoscopy and imaging is essential.

  11. Sinus Tumors

    MedlinePlus

    ... critical nerves and arteries in the area, 4) maintenance of the function of the nose, sinuses and any other involved structures, and 5) maintenance of separation between the intracranial (brain) and sinonasal ...

  12. Long-lasting airplane headache in a patient with chronic rhinosinusitis.

    PubMed

    Pfund, Z; Trauninger, A; Szanyi, I; Illes, Z

    2010-04-01

    The authors report long-lasting airplane headache in a patient with non-allergic, chronic rhinosinusitis. Association of mucosal inflammation with compromised sinonasal ventilation and sinus barotrauma created a base for not only the pain but also for the prolongation of symptoms. Effective therapy with antihistamine and nasal decongestant supports the theory that sinonasal barotrauma plays a triggering role in the pathophysiology of airplane headache.

  13. [Vesical hemangioma].

    PubMed

    Martín Martín, S; Muller Arteaga, C; Gonzalo Rodríguez, V; García Lagarto, E; Egea Camacho, J; Fernández del Busto, E

    2007-01-01

    Bladder hemangiomas are mesenquimal tumors, generally benign and of difficult diagnosis, representing only 0.6% primary bladder tumors. Fundamental diagnosis is histological, since imaging test can't differenciate this from other bladder tumors. We present a case of a 60-year-old male who came to our service with macroscopic hematuria. RTU of one blue mass in the bladder was performed and the histological examination showed to be cavernous hemangioma. A review of literature was realized, commenting on the most typical clinical aspects, the diagnostic methods and the last therapeutic techniques in this type of lesions.

  14. Mi Quinto Libro de Maquinas Simples: El Plano Inclinado. Escuela Intermedia Grados 7, 8 y 9 (My Fifth Book of Simple Machines: The Inclined Plane. Intermediate School Grades 7, 8, and 9).

    ERIC Educational Resources Information Center

    Alvarado, Patricio R.; Montalvo, Luis

    This is the fifth book in a five-book physical science series on simple machines. The books are designed for Spanish-speaking junior high school students. This volume explains the principles and some of the uses of inclined planes, as they appear in simple machines, by suggesting experiments and posing questions concerning drawings in the book…

  15. The Role That Socioaffective Practices Play in Third Graders' Autonomous Learning (El papel de las prácticas socioafectivas en el aprendizaje autónomo de estudiantes de tercer grado)

    ERIC Educational Resources Information Center

    Perdomo Toro, Jhonatan; Rico González, Ángela Milena; Huepa Salcedo, Nury Catherine

    2011-01-01

    In this article we describe and analyze how autonomous learning emerges in third graders' socioaffective practices as reconstructed in written narratives. Results were obtained by analyzing and reflecting on classroom observation, interviews and written narratives done by the students which let us appreciate different behaviors and reactions the…

  16. Using Songs to Encourage Sixth Graders to Develop English Speaking Skills (Uso de canciones para motivar a los estudiantes de grado sexto a desarrollar habilidades orales en inglés)

    ERIC Educational Resources Information Center

    Duarte Romero, Mónica Duarte; Tinjacá Bernal, Luz Mery; Carrero Olivares, Marilú

    2012-01-01

    This article contains the procedures and findings of an investigation carried out by a team of teachers with the purpose of motivating students to speak English. We observed students' lack confidence to talk and that they had little motivation toward learning English. Thus, we used songs as a main resource in conjunction with different kind of…

  17. Supplement for Curriculum Guide for Mathematics: Spanish-Speaking Students, Grades 4-6 = Supplemento de la guia didactica de matematicas para los estudiantes de habla hispana, cuatro-sexto grados. Field Test.

    ERIC Educational Resources Information Center

    Chicago Board of Education, IL.

    This supplementary math curriculum guide for use with Spanish-speaking, fouth through sixth grade students in Chicago public schools employs a contrastive analysis approach. Lessons are presented for objectives for which the instructional strategies used in the United States differ from those used in Spanish-speaking countries. (Objectives for…

  18. Mi Cuarto Libro de Maquinas Simples: Otras Modificaciones de la Rueda. Escuela Intermedia Grados 7, 8 y 9 (My Fourth Book of Simple Machines: Other Modifications of the Wheel. Intermediate School Grades 7, 8, and 9).

    ERIC Educational Resources Information Center

    Alvarado, Patricio R.; Montalvo, Luis

    This is the fourth book in a five-book physical science series on simple machines. The books are designed for Spanish-speaking junior high school students. This volume explains further refinements of the wheel which is introduced in volume three. The fourth volume explains principles behind gears and the relationship between velocity and force by…

  19. Mi Tercer Libro de Maquinas Simples: La Rueda y la Polea. Escuela Intermedia Grados 7, 8 y 9 (My Third Book of Simple Machines: The Wheel and the Pulley. Intermediate School Grades 7, 8, and 9).

    ERIC Educational Resources Information Center

    Alvarado, Patricio R.; Montalvo, Luis

    This is the third book in a five-book physical science series on simple machines. The books are designed for Spanish-speaking junior high school students. This volume explains principles governing wheels and pulleys by suggesting experiments and posing questions concerning drawings in the book which illustrate the scientific principles. Friction…

  20. La Desercion Escolar en los Niveles de Sexto y Noveno Grado: Una Comparacion Entre Zonas Rurales y Urbanas. Boletin 219 (The Educational Desertion in the 6th and 9th Grades: A Comparison Between Rural and Urban Zones. Bulletin 219).

    ERIC Educational Resources Information Center

    Lopez, Maria I. Hernandez; And Others

    In 1962 and again in 1965, a group of sixth and ninth grade students in selected schools in four Puerto Rican communities were interviewed to investigate the factors influencing students' decision to withdraw from school before completing twelfth grade and to identify some characteristics of dropouts. Of 616 students interviewed in 1962, 20.9% of…

  1. Mi Primer Libro de Maquinas Simples: Trabajo y Fuerza. Escuela Intermedia Grados 7, 8 y 9 (My First Book of Simple Machines: Work and Force. Intermediate School Grades 7, 8, and 9).

    ERIC Educational Resources Information Center

    Alvarado, Patricio R.; Montalvo, Luis

    This is the first book in a five-book physical science series on simple machines. The books are designed for Spanish-speaking junior high school students. This volume defines force and work by suggesting experiments and posing questions concerning drawings in the book which illustrate scientific principles. Answers to the questions are provided;…

  2. Mi Segundo Libro de Maquinas Simples: Las Palancas. Escuela Intermedia Grados 7, 8 y 9 (My Second Book of Simple Machines: Levers. Intermediate School Grades 7, 8, and 9).

    ERIC Educational Resources Information Center

    Alvarado, Patricio R.; Montalvo, Luis

    This is the second book in a five-book physical science series on simple machines. The books are designed for Spanish-speaking junior high school students. By suggesting experiments and posing questions concerning drawings in the book which illustrate the scientific principles, this book explains the workings of three types of levers. Resistance…

  3. La Desercion Escolar en los Niveles de Sexto y Noveno Grado: Una Comparacion Entre Zonas Rurales y Urbanas. Boletin 219 (The Educational Desertion in the 6th and 9th Grades: A Comparison Between Rural and Urban Zones. Bulletin 219).

    ERIC Educational Resources Information Center

    Lopez, Maria I. Hernandez; And Others

    In 1962 and again in 1965, a group of sixth and ninth grade students in selected schools in four Puerto Rican communities were interviewed to investigate the factors influencing students' decision to withdraw from school before completing twelfth grade and to identify some characteristics of dropouts. Of 616 students interviewed in 1962, 20.9% of…

  4. Matematicas Para La Escuela Primaria, Grado 4 (Parte 2), Comentario. Traduccion Preliminar de la Edicion en Ingles Revisada. (Mathematics for the Elementary School, Grade 4, Part 2, Teacher's Commentary. Preliminary Translation of the Revised English Edition).

    ERIC Educational Resources Information Center

    Beatty, Leslie; And Others

    This is Part 2 of the teacher's commentary for the grade 4 mathematics program. Part 2 includes the commentary for chapters 6 through 10. Topics covered include addition and subtraction, multiplication and division, geometrical figures, lines and lineal measurement, and fractions. (RH)

  5. Supplement for Curriculum Guide for Mathematics: Spanish-Speaking Students, Grades 2-3 = Supplemento de la guia didactica de matematicas para los estudiantes de habla hispana, segundo y tercer grados. Field Test.

    ERIC Educational Resources Information Center

    Chicago Board of Education, IL.

    A contrastive analysis approach is used in this supplementary math curriculum guide for Spanish-speaking second and third grade students in Chicago public schools. Lessons are presented for those objectives for which the instructional strategies used in the United States differ from those used in Spanish-speaking countries. (Objectives for which…

  6. Matematicas Para La Escuela Primaria, Grado 4 (Parte 1), Comentario. Traduccion Preliminar de la Edicion en Ingles Revisada. (Mathematics for the Elementary School, Grade 4, Part 1, Teacher's Commentary. Preliminary Translation of the Revised English Edition).

    ERIC Educational Resources Information Center

    Beatty, Leslie; And Others

    This is Part 1 of the teacher's commentary for the grade 4 mathematics program. Part 1 includes the commentary for chapters 1 through 5. Topics covered include congruence, numbers and number bases, subtraction of numbers, division of numbers, and elementary geometry. References to the student text are cited. (RH)

  7. Supplement for Curriculum Guide for Mathematics: Spanish-Speaking Students, Grades 7-8 = Supplemento de la guia didactica de matematicas para los estudiantes de habla hispana, septimo y octavo grados. Field Test.

    ERIC Educational Resources Information Center

    Chicago Board of Education, IL.

    This supplementary math curriculum guide for use with Spanish-speaking students in Chicago public schools' seventh and eighth grade classes employs a contrastive analysis approach. Lessons are presented for objectives for which the instructional strategies used in the United States differ from those in Spanish-speaking countries. (Objectives for…

  8. The Role of Innate Immunity and Aeroallergens in Chronic Rhinosinusitis.

    PubMed

    London, Nyall R; Tharakan, Anuj; Ramanathan, Murugappan

    2016-01-01

    Allergy has been inferred to contribute to the pathophysiology of chronic rhinosinusitis (CRS) although this role is controversial and the mechanism is debated. Furthermore, the role of aeroallergens in CRS is poorly defined and has been postulated to contribute to CRS through direct penetration in the sinuses or downstream systemic consequences. Common aeroallergens implicated in chronic rhinosinusitis include air pollution/second hand smoke, dust mite and pollen [1,2,3]. One emerging potential mechanism whereby aeroallergens contribute to CRS is through sinonasal epithelial barrier disruption (fig. 1). Characterization of cytokine disruption of sinonasal epithelial cell barrier has been described including interleukin (IL)-4 and IL-13, as well as aeroallergens such as house dust mite and cigarette smoke. Recent results have demonstrated severe barrier disruption in response to direct application of either particulate matter (PM) or house dust mite (HDM) to sinonasal epithelial cells. Sinonasal epithelial barrier disruption may contribute to CRS by enabling the perpetual and chronic exposure of inflammatory allergens and stimuli. The sinonasal epithelial barrier plays a significant role in innate immune host defense. Mechanisms of innate immune defense include pattern recognition receptors (PRRs), secreted endogenous antimicrobials and inflammatory cytokines that aid in repair mechanisms including IL-33. Here we discuss recent evidence implicating aeroallergens and dysregulated host innate immune responses in the development of CRS.

    1Fig. 1. Aeroallergens and inflammatory stimuli disrupt sinonasal epithelial barrier function. These agents act to destabilize the barrier through stimulating endocytosis and destruction of cell junction proteins via oxidative stress and MyD88-dependent mechanisms. Furthermore

  9. BRAF, NRAS, KIT, TERT, GNAQ/GNA11 mutation profile analysis of head and neck mucosal melanomas: a study of 42 cases.

    PubMed

    Öztürk Sari, Şule; Yilmaz, İsmaİl; Taşkin, Orhun Çiğ; Narli, Gİzem; Şen, Fatma; Çomoğlu, Şenol; Firat, Pinar; Bİlgİç, Bİlge; Yilmazbayhan, Dİlek; Özlük, Yasemİn; Büyükbabanİ, Nesİmİ

    2017-01-01

    Head and neck mucosal melanoma (HNMuM), which occurs mostly in the sinonasal and oral cavity, constitutes less than 1% of all malignant melanomas. Treatment options fail to improve the prognosis of this aggressive tumour that has low overall survival rates. Thus, development of new targeted therapies is essential. Unfortunately, limited data exist regarding their molecular profile. BRAF, NRAS, KIT, TERT and GNAQ/GNA11 oncogene mutations were investigated in 42 HNMuMs (28 sinonasal, 13 oral, 1 nasopharyngeal). Mutation rates were as follows: BRAF (4.8%), NRAS (4.8%), KIT (9.5%), TERT (7.5%), GNAQ/GNA11 (0%). Among 11 cases that harboured mutations (26%), 10 (91%) were located in sinonasal and one (9%) in the oral cavity. The literature was reviewed with comparison of frequencies based on the gathered data. NRAS and TERT promoter mutation rates were significantly higher in sinonasal than in oral location (p<0.05). Our results indicated that BRAF, NRAS, KIT, TERT and GNAQ/GNA11 gene mutations occur at low frequencies in HNMuMs, and subgroups (oral versus sinonasal) differ in their molecular profile. Low rates of aforementioned mutations and activation of oncogenes by pathways other than sun exposure support the distinctive nature of HNMuMs with regard to their cutaneous counterparts. Copyright © 2016 Royal College of Pathologists of Australasia. Published by Elsevier B.V. All rights reserved.

  10. Skull invaders: when surgical pathology and neuropathology worlds collide.

    PubMed

    Serracino, Hilary S; Kleinschmidt-Demasters, B K

    2013-07-01

    Skull and dura serve as effective barriers to penetration by most tumors, often preventing masses originating intracranially from extending into the contiguous bone and soft tissues, or those arising in head and neck regions from extending into the dura and brain tissue. We review our 15-year experience with extracranial tumors that had sufficiently invaded adjacent skull, dura, or brain from the "outside-in" to require a neurosurgeon to participate in the surgical resection and discuss our 40 cases in context with the literature. Sinonasal-origin tumors (n = 17) and cutaneous tumors (n = 10) were the most frequent skull-invaders. Most of the cutaneous tumor types were squamous cellcarcinomas (n = 9); diverse sinonasal-origin types included 4 squamous cell carcinomas, 4 adenoid cystic carcinomas, 2 sinonasal undifferentiated carcinomas, 2 sinonasal adenocarcinomas, and single examples each of sinonasal-origin hemangiopericytoma, solitary fibrous tumor, melanoma, mucocele, and teratocarcinoma. There were 9olfactory neuroblastomas, and middle ear-origin basal cell carcinoma,recurrent glomus jugulare, and orbital malignant hidradenoma were also seen. Unique tumors included a cutaneous cylindroma invasive of skull convexity occurring in familial cylindromatosis and a ganglioneuroma of the middle ear with massive bilateral skull base extension. Convexity dural spread, a seldom-reported pattern of dissemination, was seen in 1 olfactory neuroblastoma and 1 adenoid cystic carcinoma. The ability to show skull/dural invasion did not correlate with specific histopathologic features; even benign tumor types can show skull/dural penetration.

  11. Symptom-based Clustering In Chronic Rhinosinusitis Relates To History of Aspirin Sensitivity and Post-surgical Outcomes

    PubMed Central

    Divekar, Rohit; Patel, Neil; Jin, Jay; Hagan, John; Rank, Matthew; Lal, Devyani; Kita, Hirohito; O’Brien, Erin

    2015-01-01

    Background Symptoms burden in chronic rhinosinusitis (CRS) may be assessed by interviews or by means of validated tools such as the 22-item sinonasal outcome test (SNOT-22). However, when only total SNOT-22 scores are used, the pattern of symptom distribution and heterogeneity in patient symptoms is lost. Objectives To use a standardized symptom assessment tool (SNOT-22) on pre-operative symptoms to understand symptom heterogeneity in CRS and to aid in characterization of distinguishing clinical features between subgroups. Methods This was a retrospective review of ninety-seven surgical CRS patients. Symptom based clusters were derived based on presurgical SNOT-22 scores using unsupervised analysis and network graphs. Comparison between clusters was performed for clinical and demographic parameters, post-surgical symptom scores, and presence or absence of a history of aspirin sensitivity. Results Unsupervised analysis reveals co-clustering of specific symptoms in the SNOT-22 tool. Using symptom based clustering; CRS patients were stratified into severe overall (mean total score 90.8), severe sinonasal (score of 62), moderate sinonasal (score 40), moderate non-sinonasal (score 37) and mild sinonasal clusters (score 16). The last 2 clusters were associated with lack of history of aspirin sensitivity. The first cluster had a rapid relapse in symptoms post-operatively and the last cluster demonstrated minimal symptomatic improvement after surgery Conclusion Symptom based clusters in chronic rhinosinusitis reveal a distinct grouping of symptom burden which may relate to aspirin sensitivity and treatment outcomes. PMID:26216252

  12. PubMed Central

    Parrilla, C.; Petrone, G.; Bastanza, G.; Colosimo, C.

    2017-01-01

    SUMMARY Olfactory neuroblastoma (ONB) is an uncommon neuroendocrine sinonasal cancer associated by many authors to ectopic production of several biologically active substances. We report a case of a 31-year-old male patient who presented with idiopathic syndrome of inappropriate secretion of antidiuretic hormone (SIADH). During diagnostic work-up, a CT scan of the head was performed and an ethmoidal ONB was detected. Endoscopical surgery followed by radiotherapy was carried out. Immediately after surgery natraemia levels normalised. Five years later the patient is disease-free. To our knowledge, 17 cases of SIADH associated to ONB have been published. In nine reports, idiopathic SIADH promptly led to the diagnosis of the sinonasal mass as in our clinical case, however, in many reports, correct diagnosis was accomplished months to years later. In young patients with idiopathic inappropriate antidiuretic hormone secretion, a neuroendocrine malignancy of the sinonasal area must be excluded. PMID:28374875

  13. Mucosal cavernous hemangioma of the maxillary sinus.

    PubMed

    Dutta, Mainak; Kundu, Sohag; Barik, Sabyasachi; Banerjee, Shoham; Mukhopadhyay, Subrata

    2015-02-01

    Mucosal cavernous hemangiomas of maxillary sinus and the lateral nasal wall are seldom encountered and difficult to diagnose with misleading radiologic features like bone erosion and heterogeneity due to patchy contrast uptake. The overall picture mimicking sinonasal malignancy, it is unclear whether there is true breach in the bone or remodeling due to the lesion's chronicity. Interestingly, it often does not bleed as expected during surgery, questioning the use of therapeutic embolization and pre-intervention vascular shrinkage. The clinical presentation and management protocol of sinonasal cavernous hemangiomas seem greatly individualized. We here present a patient with cavernous hemangioma of maxillary sinus and discuss the distinguishing clinical, histologic and imaging characteristics and subsequent management options, and attempt to establish the findings as the basis of considering it as an important differential diagnosis of radiologically heterogeneous sinonasal mass with suspected bone erosions presenting with nasal obstruction and epistaxis, mostly in young women.

  14. Chronic Rhinosinusitis Pathogenesis

    PubMed Central

    Stevens, Whitney W.; Lee, Robert J.; Schleimer, Robert P.; Cohen, Noam A.

    2015-01-01

    There are a variety of medical conditions associated with chronic sinonasal inflammation including chronic rhinosinusitis (CRS) and cystic fibrosis. CRS in particular can be divided into two major subgroups based upon whether nasal polyps are present (CRSwNP) or absent (CRSsNP). Unfortunately, clinical treatment strategies for patients with chronic sinonasal inflammation are limited, in part because the underlying mechanisms contributing to disease pathology are heterogeneous and not entirely known. It is hypothesized that alterations in mucociliary clearance, abnormalities in the sinonasal epithelial cell barrier and tissue remodeling all contribute to the chronic inflammatory and tissue deforming processes characteristic of CRS. Additionally, the host innate and adaptive immune responses are also significantly activated and may be involved in pathogenesis. Recent advancements in the understanding of CRS pathogenesis are highlighted in this review with special focus placed on the roles of epithelial cells and the host immune response in cystic fibrosis, CRSsNP and CRSwNP. PMID:26654193

  15. The nose and nasal vault.

    PubMed

    Vogelzang, P J; Babbel, R W; Harnsberger, H R

    1991-12-01

    In this article we have reviewed the anatomy of the nose and nasal vault, with emphasis on specific features that are imaged with the SSCT. Important areas of the lateral wall anatomy include the OMU and SER, areas that are key to understanding the obstructive patterns of inflammatory sinonasal disease. Lesions that result in these specific obstructive patterns include anatomic variants and other focal pathological lesions, such as polyps. Other types of sinonasal inflammatory disease include sinonasal polyposis and granulomatous and fungal disease. Congenital lesions of the nose may be understood through a knowledge of the relevant developmental anatomy. These lesions include nasal dermoids and epidermoids, cephaloceles, gliomas, and choanal atresia. Important benign masses include antrochoanal polyps, inverting papillomas, angiomatous polyps, JNAs, and osteomas. Benign nasal masses have characteristic features that distinguish them from malignant lesions. Malignant nasal tumors, such as SSCa, esthesioneuroblastoma, and others, are characterized by their more aggressive and destructive behavior.

  16. IMAGING DIAGNOSIS: COMPUTED TOMOGRAPHIC FINDINGS IN A CASE OF ADENOSQUAMOUS CARCINOMA OF THE HEAD AND NECK IN A CAT.

    PubMed

    Chow, Kathleen Ella; Krockenberger, Mark; Collins, David

    2016-01-01

    A 15-year-old female spayed domestic long-haired cat was referred for trismus, hypersalivation, and bilateral ocular discharge. On examination, the cat showed pain on palpation of the left zygomatic arch, palpable crepitus of the frontal region, and limited retropulsion of both globes. A contrast-enhanced sinonasal computed tomographic study was performed, showing facial distortion and extensive osteolysis of the skull, extending beyond the confines of the sinonasal and paranasal cavities. Additionally, soft tissue and fluid accumulation were observed in the nasal cavities and paranasal sinuses. Postmortem biopsy samples acquired from the calvarium yielded a histologic diagnosis of sinonasal adenosquamous carcinoma, a rare and particularly aggressive neoplasm previously only reported in the esophagus of one cat.

  17. Pleomorphic adenoma in the nasal cavity: a clinicopathological study of ten cases in Finland.

    PubMed

    Vento, S I; Numminen, J; Kinnunen, I; Rautiainen, M; Tarkkanen, J; Hagström, J; Mäkitie, A A

    2016-11-01

    The objective of the study was to investigate the nationwide occurrence of sinonasal pleomorphic adenoma in Finland. A retrospective study was conducted at The Departments of Otorhinolaryngology-Head and Neck Surgery, and Pathology at the five university hospitals in Finland. Data were obtained by searching for sinonasal pleomorphic adenoma cases in the clinical and histopathological registries at these institutions for the past two to four decades. All patients who had had a histologically proven pleomorphic adenoma in the sinonasal area were included as participants. Ten cases with pleomorphic adenoma of the nasal cavity were found. The majority of these tumours originated in the septum, and there were no malignant transformations. Pleomorphic adenomas of the nasal cavity were found to be extremely rare in this nationwide investigation.

  18. Rhinology-specific priority setting for quality improvement: a modified Delphi study from the Quality Improvement Committee of the American Rhinologic Society.

    PubMed

    Rudmik, Luke; Mattos, Jose L; Stokken, Janalee K; Soler, Zachary M; Manes, R Peter; Higgins, Thomas S; Setzen, Michael; Lee, Jivianne; Schneider, John

    2017-10-01

    Improving the quality of healthcare is a complex and resource intensive process. To optimize the allocation of scarce resources, quality improvement (QI) should focus on high-value diseases that will produce the largest improvement in health system performance. Given the breadth and multidisciplinary nature of sinonasal disease management, the purpose of this study was to transparently develop a prioritized list of sinonasal diseases for QI from the perspective of the specialty of rhinology and the American Rhinologic Society (ARS). The RAND modified Delphi methodology was used to rank the priority of nine sinonasal disease categories from 1 (lowest priority) to 9 (highest priority). Two rounds of ranking along with a teleconference meeting was performed by a panel of 9 experts from the ARS Quality Improvement Committee. The final QI-prioritized list of sinonasal diseases are as follows: chronic rhinosinusitis (CRS) (mean score = 8.9), recurrent acute rhinosinusitis (RARS) (mean score = 7.9), sinonasal neoplasms (mean score = 7.0), anatomic nasal obstruction (mean score = 5.9), refractory epistaxis (mean score = 5.2), complicated acute rhinosinusitis (mean score = 5.2), chronic nonallergic rhinitis (mean score = 4.4), orbital disease (mean score = 4.3), uncomplicated acute rhinosinusitis (mean score = 4.1), and allergy/allergic rhinitis (mean score = 3.7). The three most important disease categories for QI from the perspective of the specialty of rhinology were CRS, RARS, and sinonasal neoplasms. Future studies need to define and validate quality metrics for each of these important disease categories in order to facilitate appropriate measurement and improvement initiatives. © 2017 ARS-AAOA, LLC.

  19. Diagnostic tools in Rhinology EAACI position paper

    PubMed Central

    2011-01-01

    This EAACI Task Force document aims at providing the readers with a comprehensive and complete overview of the currently available tools for diagnosis of nasal and sino-nasal disease. We have tried to logically order the different important issues related to history taking, clinical examination and additional investigative tools for evaluation of the severity of sinonasal disease into a consensus document. A panel of European experts in the field of Rhinology has contributed to this consensus document on Diagnostic Tools in Rhinology. PMID:22410181

  20. Unusual presentations of intracranial meningiomas: Report of two cases and review of the literature.

    PubMed

    Dhingra, Shruti; Gandhi, Jatin Sundersham; Gupta, Divya

    2015-01-01

    Meningiomas at extracranial sites are uncommon clinical presentations. They may present in the form of benign, slow.growing masses or may exhibit aggressive malignant behavior. We report two cases of intracranial meningiomas presenting at extracranial sites that are, at the sinonasal tract/external auditory canal and as a neck mass. The clinical presentations, histopathological features and appropriate management are discussed.

  1. Malignant Tumors of the Nasal Cavity and Paranasal Sinuses: Long-Term Outcome and Morbidity With Emphasis on Hypothalamic-Pituitary Deficiency

    SciTech Connect

    Snyers, An Janssens, Geert; Twickler, Marcel B.; Hermus, Ad R.; Takes, Robert P.; Kappelle, Arnoud C.; Merkx, Matthias A.W.; Dirix, Piet; Kaanders, Johannes H.A.M.

    2009-04-01

    Purpose: To evaluate the long-term outcome after surgery and radiotherapy for patients with sinonasal cancer and assess late toxicity, with special emphasis on hypothalamic-pituitary dysfunction. Methods and Materials: A retrospective analysis of 168 patients treated for sinonasal cancer in a single institute between 1986 and 2006. A more detailed analysis was performed on a subgroup of 76 patients with adenocarcinoma or squamous cell carcinoma treated with curative intent. Long-term survivors were evaluated for late toxicity by a multidisciplinary team using the late effects of normal tissues (LENT SOMA) scoring system. Additional endocrinologic tests were performed for assessment of hypothalamic-pituitary function. Results: Five-year actuarial local control and overall survival rates were 62% and 35% for all patients and 64% and 42% for the subgroup with squamous cell carcinoma and adenocarcinoma. In multivariate analysis, T stage was the only significant factor predicting local relapse (79% at 5 years for T1-T3 vs. 53% for T4; p = 0.006). Sinonasal mucosal melanomas had the highest rate of regional failure (33% at 5 years). Thirteen of 21 patients (62%) evaluated at the late morbidity clinic had hormonal disturbances, of whom 5 (24%) had definitive evidence of hypopituitarism with multiple hormonal deficiencies. Conclusion: Local failure is the dominant cause of treatment failure for patients with sinonasal cancer, with T4 stage the only independent predictor. Because of a high rate of radiation-induced hypopituitarism, we recommend endocrinologic surveillance for these patients.

  2. Bilateral respiratory epithelial adenomatoid hamartomas originating from the anterior olfactory clefts

    PubMed Central

    Falco, Jeffrey J.; Peine, Brandon S.

    2017-01-01

    A respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon benign lesion often found in the sinonasal tract. We present a case of bilateral REAH originating from the anterior olfactory cleft treated with endoscopic surgical resection without recurrence. We highlight the characteristics of REAH and necessary steps to ensure proper diagnosis and treatment. PMID:28405090

  3. Benign ear cyst or tumor

    MedlinePlus

    ... Bony tumor of the ear canal Images Ear anatomy References Nicolai P, Castelnuovo P. Benign tumors of the sinonasal tract. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; ...

  4. Long-term outcomes of endoscopic endonasal approach for skull base surgery: a prospective study.

    PubMed

    Rioja, Elena; Bernal-Sprekelsen, Manuel; Enriquez, Karla; Enseñat, Joaquim; Valero, Ricard; de Notaris, Matteo; Mullol, Joaquim; Alobid, Isam

    2016-07-01

    Little is known about the long-term effects of either transnasal transsphenoidal endoscopic approach (TTEA) or expanded endonasal approach (EEA). This study assessed the long-term impact of endoscopic skull base surgery on olfaction, sinonasal symptoms, mucociliary clearance time (MCT), and quality of life (QoL). Patients with pituitary adenomas underwent TTEA (n = 38), while patients with other benign parasellar tumours who underwent an EEA with vascularised septal flap reconstruction (n = 17) were enrolled in this prospective study between 2009 and 2012. Sinonasal symptoms (Visual Analogue Scale), subjective olfactometry (Barcelona Smell Test-24, BAST-24), MCT (saccharin test), and QoL (short form SF-36, rhinosinusitis outcome measure/RSOM) were evaluated before, and 12 months after, surgery. At baseline, sinonasal symptoms, MCT, BAST-24, and QoL were similar between groups. Twelve months after surgery, both TTEA and EEA groups experienced smell impairment compared to baseline. Moreover, EEA (but not TTEA) patients reported increased posterior nasal discharge and longer MCTs compared to baseline. No significant changes in olfactometry or QoL were detected in either group 12 months after surgery. Over the long-term, expanded skull base surgery, using EEA, produced more sinonasal symptoms (including loss of smell) and longer MCTs than pituitary surgery (TTEA). EEA showed no long-term impact on smell test or QoL. IIb.

  5. Sarcoidosis with involvement of the paranasal sinuses - a retrospective analysis of 12 biopsy-proven cases

    PubMed Central

    2013-01-01

    Background Extrapulmonary involvement by sarcoidosis is observed in about 30–40% of patients with sarcoidosis. Little is known about the frequency and clinical characteristics of sinonasal sarcoidosis. Methods We retrospectively analyzed 12 cases of biopsy-proven sinonasal sarcoidosis. Patients were identified from a patient population of 1360 patients with sarcoidosis at the Outpatient Clinic for Sarcoidosis and Rare Lung Diseases at LungClinic Grosshansdorf, a tertiary care hospital for respiratory medicine. Results The most frequent signs and symptoms were nasal polyps (4 cases), epistaxis (3 cases), nasal crusts (8 cases) and anosmia (5 cases). Pulmonary sarcoidosis of the patients was staged as stage I (n = 1) and stage II (n = 11) on chest radiographs. Spirometry was normal in 11 patients. 7 patients had a diffusion capacity of the lung for carbon monoxide of less than 90% of predicted. Other organs were affected in 8 patients. All patients received systemic corticosteroid treatment and most patients received topical steroids. 5 patients received steroid sparing agents. Repeated sinus surgery had to be performed in 4 patients. Conclusions Sinonasal involvement is a rare disease manifestation of sarcoidosis with a frequency slightly lower than 1% in our patient population. The clinical course of sinonasal sarcoidosis can be complicated by relapse despite systemic immunosuppressive treatment and repeated sinus surgery. PMID:24070015

  6. Viviremos! On the Road to Healthy Living: A Bilingual Curriculum on AIDS and HIV Prevention for Migrant Students (Grades 6-12) = El Camino Hacia la Salud: Un Programa de Estudio Bilingue sobre la Prevencion del SIDA y del VIH para Estudiantes Migrantes (Grados 6-12).

    ERIC Educational Resources Information Center

    VAMOS (Villarreal Analytical Management and Organizational Services), San Marcos, TX.

    This curriculum provides the basic information everyone needs to avoid HIV infection, but was specifically designed for Latino farmworker students in grades 6-7. The student materials are written in Spanish and English and may be used with older student or young adults, or in English-as-a-second-language courses. An introduction provides…

  7. Una guia para los padres sobre lo mas importante: el logro academico plan de educacion de Maryland desde preescolar hasta el 12 grado, 2002-2003. (A Parent's Guide to Achievement Matters Most: Maryland's Plan for PreK-12 Education, 2002-2003).

    ERIC Educational Resources Information Center

    Maryland State Dept. of Education, Baltimore.

    To raise the achievement of every student in the state, Maryland implemented "Achievement Matters Most," a new plan for public elementary and secondary schools that sets goals in the areas of achievement, teaching, testing, safety, and family involvement in schools. This Spanish-language guide for parents outlines the goals and…

  8. Improving Eleventh Graders' Reading Comprehension through Text Coding and Double Entry Organizer Reading Strategies (Mejoramiento de la comprensión lectora de estudiantes de grado once mediante las estrategias de lectura de codificación de texto y organizador de doble entrada)

    ERIC Educational Resources Information Center

    Mahecha, Rocío; Urrego, Stella; Lozano, Erika

    2011-01-01

    In this article we report on an innovation project developed with a group of eleventh graders at a public school in Bogotá. Its aim was to encourage students to improve reading comprehension of texts in English. It was conducted taking into account students' needs, interests and level of English. To do it, we implemented two reading strategies:…

  9. A Guide for Parents and Families about What Your 11th Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de Grado 11 Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  10. Viviremos! On the Road to Healthy Living: A Bilingual Curriculum on AIDS and HIV Prevention for Migrant Students (Grades 6-12) = El Camino Hacia la Salud: Un Programa de Estudio Bilingue sobre la Prevencion del SIDA y del VIH para Estudiantes Migrantes (Grados 6-12).

    ERIC Educational Resources Information Center

    VAMOS (Villarreal Analytical Management and Organizational Services), San Marcos, TX.

    This curriculum provides the basic information everyone needs to avoid HIV infection, but was specifically designed for Latino farmworker students in grades 6-7. The student materials are written in Spanish and English and may be used with older student or young adults, or in English-as-a-second-language courses. An introduction provides…

  11. Exploring Knowledge of English Speaking Strategies in 8th and 12th Graders (Exploración del conocimiento de las estrategias de expresión oral en inglés en estudiantes de los grados octavo y doceavo)

    ERIC Educational Resources Information Center

    Diaz Larenas, Claudio

    2011-01-01

    This article presents a research study that analyses eighth and twelfth graders' knowledge of speaking strategies to communicate in English. The Oral Communication Strategy Inventory, developed by Nakatani in 2006, was applied to 108 students belonging to the public, semi-public and private educational sectors in Chile. The findings show that 8th…

  12. Promoting Tenth Graders' Reading Comprehension of Academic Texts in the English Class (Promoción de la comprensión de lectura de textos académicos de estudiantes de grado décimo en la clase de inglés)

    ERIC Educational Resources Information Center

    Quiroga Carrillo, Claudia

    2010-01-01

    This article reports on an action research project conducted in a public school in Bogotá, Colombia, with tenth grade students. We decided to develop it because of the students' needs as well as the em phasis of the PEI (Proyecto Educativo Institucional = School Institutional Project), which is based on the requisite of improving reading…

  13. A Guide for Parents and Families about What Your 5th Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de 5to Grado Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  14. A Guide for Parents and Families about What Your 8th Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de Octavo Grado Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  15. A Guide for Parents and Families about What Your 7th Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de Septimo Grado Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  16. A Guide for Parents and Families about What Your 2nd Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de 2do Grado Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  17. A Guide for Parents and Families about What Your 3rd Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de 3er Grado Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  18. A Guide for Parents and Families about What Your 10th Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de Decimo Grado Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Education Oversight Committee, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  19. A Guide for Parents and Families about What Your 4th Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de 4to Grado Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  20. A Guide for Parents and Families about What Your 6th Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de 6to Grado Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  1. A Guide for Parents and Families about What Your 1st Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de 1er Grado Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  2. A Guide for Parents and Families about What Your 9th Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de Noveno Grado Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  3. A Guide for Parents and Families about What Your 12th Grader Should Be Learning in School This Year. Don't Fail Your Children = Una Guia para los Padres y Familias Acerca de Lo Que Su Hijo de Grado 12 Debe Aprender en la Escuela Este Ano. No Le Falle a Sus Hijos.

    ERIC Educational Resources Information Center

    South Carolina State Education Oversight Committee, Columbia.

    This guide, in English- and Spanish-language versions, shares with parents information about the South Carolina Curriculum Standards. The standards outline state requirements for children's learning and what students across the state should be able to do in certain subjects. The guide lists seven key reasons parents should be aware of the new…

  4. Consejos para los Padres Sobre la Lectura: Informacion e Ideas para Ayudar a los Ninos Desde la Infancia Hasta Octavo Grado a Tener Exito en la Lectura (Tips for Parents about Reading: Information and Ideas for Helping Children through Grade Eight Succeed with Reading).

    ERIC Educational Resources Information Center

    Davis, Deborah; Lewis, Jan Patricia

    Noting that all parents want the best school experience for their children, this booklet, in Spanish, gives parents some ideas about what to expect at different ages and stages of reading development, suggestions for what parents can do at home, and a list of favorite books parents can find in most libraries for parents and children to read.…

  5. New insights into upper airway innate immunity

    PubMed Central

    Hariri, Benjamin M.

    2016-01-01

    Background: Protecting the upper airway from microbial infection is an important function of the immune system. Proper detection of these pathogens is paramount for sinonasal epithelial cells to be able to prepare a defensive response. Toll-like receptors and, more recently, bitter taste receptors and sweet taste receptors have been implicated as sensors able to detect the presence of these pathogens and certain compounds that they secrete. Activation of these receptors also triggers innate immune responses to prevent or counteract infection, including mucociliary clearance and the production and secretion of antimicrobial compounds (e.g., defensins). Objective: To provide an overview of the current knowledge of the role of innate immunity in the upper airway, the mechanisms by which it is carried out, and its clinical relevance. Methods: A literature review of the existing knowledge of the role of innate immunity in the human sinonasal cavity was performed. Results: Clinical and basic science studies have shown that the physical epithelial cell barrier, mucociliary clearance, and antimicrobial compound secretion play pivotal innate immune roles in defending the sinonasal cavity from infection. Clinical findings have also linked dysfunction of these defense mechanisms with diseases, such as chronic rhinosinusitis and cystic fibrosis. Recent discoveries have elucidated the significance of bitter and sweet taste receptors in modulating immune responses in the upper airway. Conclusion: Numerous innate immune mechanisms seem to work in a concerted fashion to keep the sinonasal cavity free of infection. Understanding sinonasal innate immune function and dysfunction in health and disease has important implications for patients with respiratory ailments, such as chronic rhinosinusitis and cystic fibrosis. PMID:27657896

  6. Intraoral Mass Presenting as Maxillary Sinus Carcinoma: A Case Report

    PubMed Central

    Mahdavi, Omid; Boostani, Najmehalsadat; Karimi, Sharareh; Tabesh, Adel

    2013-01-01

    Sinonasal undifferentiated carcinoma is an extremely rare malignancy of the paranasal sinuses and nasal cavity. It is of unknown etiology, and occurs more commonly in the elderly men, with a routinely shown aggressive behavior and poor prognosis for survival. Radiographically, it looks like severe osteomyelitis. Histopathologic study is essential to confirm diagnosis, and the undifferentiated histologic appearance often necessitates immunohistochemical studies for differentiation from other high-grade neoplasms. We present an 83-year-old man complaining of pain and unilateral swelling on the left side of the face due to a rare malignant tumor of maxillary sinus origin, a sinonasal undifferentiated carcinoma. He underwent hemimaxillectomy and radiotherapy, but refused chemotherapy. Maxillary sinus malignancy may be presented with unspecific symptoms mimicking sinusitis or dental pain. Coming across such symptoms, the physician or dentist must consider malignancies as well, and carry out medical and dental workups. PMID:24910668

  7. [Nasal extranodal NK/T cell lymphoma: terminologic evaluation and diagnostic problems].

    PubMed

    Wang, Zhibin

    2010-09-01

    To review on the evolution in the understanding of midline destructive lesions of the sinonasal tract in different period, and to describe the clinical features and diagnostic problems on the nasal extranodal NK/T cell lymphoma (NENKTCL). To retrospectively study the nasal CT scannings and the results of serum ANCA of 10 patients with typical clinical characteristics. All patients presented with the symptoms of the nasal obstruction and the nasal discharge. Epistaxis and facial swelling were in the clinical spectrum. Nasal endoscopy and CT scan of paranasal sinuses showed destructive sinonasal lesions. Ten patients were finally diagnosed as having NENKTCL by the pathologic findings combined with immunohistochemical phenotyping. Clinically, Nasal lesions in the cases were similar to those from historical nomenclature. Outdated terminology referring to midline lesions includes a variety of diseases, and NENKTCL is an independent disease focusing on destructive lesions of face and nose.

  8. An Eustachian Tube Neuroendocrine Carcinoma: A Previously Undescribed Entity and Review of the Literature

    PubMed Central

    Lin, Vincent Y.; Lee, John M.

    2016-01-01

    Primary sinonasal and middle ear neuroendocrine carcinomas are rare malignancies of the head and neck. Owing to the rarity of these tumors, the clinical behavior and optimal management of these tumors are not well defined. We present a case of an incidentally discovered sinonasal neuroendocrine carcinoma that was found to originate from the Eustachian tube, which has not previously been described in the literature. This patient was treated with primary surgical resection using a combination of transnasal and transaural approaches and achieved an incomplete resection. Follow-up imaging demonstrated continued tumor growth in the Eustachian tube as well as a new growth in the ipsilateral cerebellopontine angle and findings suspicious of perineural invasion. However, the tumor exhibited a benign growth pattern and despite continued growth the patient did not receive additional treatment and he remains asymptomatic 35 months following his original surgery. PMID:27429827

  9. PubMed Central

    BATTAGLIA, P.; BIGNAMI, M.; FERRELI, F.; TURRI-ZANONI, M.; BERNARDINI, E.; LENZI, R.; DALLAN, I.

    2012-01-01

    SUMMARY The surgical treatment of sinonasal malignancies is in continuous evolution. In selected patients, endoscopic resection has become a sound alternative to traditional external approaches. Further improvements are necessary to enhance the possibilities of endoscopic transnasal resection of sinonasal malignancies. We present a case of intestinal-type adenocarcinoma of the left nasal fossa eroding the skull base that affected a 56-year-old male. The patient was surgically-treated by means of a four-hand binarial endoscopic transnasal resection using a 3D endoscopic system and neuronavigation. Surgery was completed in 5 hours without significant complications. Surgeons were able to recognize and manage anatomical structures, and to control bleeding easily thanks to the bimanual technique and 3D visualization. The new 3D scopes and the bimanual technique under the guidance of a navigation system represent an interesting solution that can overcome the traditional limits of the traditional set up currently used. PMID:22767985

  10. RGS21, a regulator of taste and mucociliary clearance?

    PubMed

    Kimple, Adam J; Garland, Alaina L; Cohen, Staci P; Setola, Vincent; Willard, Francis S; Zielinski, Thomas; Lowery, Robert G; Tarran, Robert; Siderovski, David P

    2014-03-01

    Motile cilia of airway epithelial cells help to expel harmful inhaled material. Activation of bitterant-responsive G protein-coupled receptors (GPCRs) is believed to potentiate cilia beat frequency and mucociliary clearance. In this study, we investigated whether regulator of G protein signaling-21 (RGS21) has the potential to modulate signaling pathways connected to airway mucociliary clearance, given that RGS proteins modulate GPCR signaling by acting as GTPase-accelerating proteins (GAPs) for the Gα subunits of heterotrimeric G proteins. This is a pilot investigation to determine if RGS21, a potential tastant specific RGS gene, is expressed in sinonasal mucosa, and to determine its specific Gα substrate using in vitro biochemical assays with purified proteins. Rgs21 expression in sinonasal mucosa was determined using quantitative, real-time PCR and a transgenic mouse expressing RFP from the Rgs21 promoter. Rgs21 was cloned, over-expressed, and purified using multistep protein chromatography. Biochemical and biophysical assays were used to determine if RGS21 could bind and accelerate the hydrolysis of GTP on heterotrimeric Gα subunits. Rgs21 was expressed in sinonasal mucosa and lingual epithelium. Purified recombinant protein directly bound and accelerated GTP hydrolysis on Gα subunits. Rgs21 is expressed in sinonasal mucosa, is amenable to purification as a recombinant protein, and can bind to Gα(i/o/q) subunits. Furthermore, RGS21 can accelerate the hydrolysis rate of GTP on Gαi subunits. This provides evidence that RGS21 may be a negative regulator of bitterant responses. Future studies will be needed to determine the physiological role of this protein in mucociliary clearance. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  11. Maxillary sinus cavernous hemangioma: a rare entity.

    PubMed

    Jammal, H; Barakat, F; Hadi, U

    2004-04-01

    Vascular lesions of the sinonasal tract are rare. These lesions do not have typical signs or symptoms. They may present insidiously with minimal symptoms. A high index of suspicion and a good preoperative evaluation are needed for diagnosis. No standard surgical approach is indicated. We report a case of cavernous hemangioma of the maxillary sinus in an adult male. We present the diagnostic work-up and discuss the differential diagnosis and potential therapeutic approaches.

  12. Fine needle aspiration cytology in lesions of the nose, nasal cavity and paranasal sinuses.

    PubMed

    Gupta, Nalini; Kaur, Jasleen; Srinivasan, Radhika; Das, Ashim; Mohindra, Satyawati; Rajwanshi, Arvind; Nijhawan, Raje

    2011-01-01

    To assess the spectrum of lesions in the sinonasal region diagnosed on FNAC. This is a retrospective audit of sinonasal lesions diagnosed on FNAC over a period of 12 years (1998-2009). Out of a total of 79,851 FNACs, 158 (0.2%) were from the sinonasal region. FNAC was non-diagnostic in 20 (12.6%) cases. Infective/inflammatory lesions comprised of 30 (19%) cases including non-specific inflammation (19), fungal infection (7), tuberculosis (2), actinomycosis (1) and filariasis (1). Benign cysts (24; 15.2%) included epidermal inclusion cysts, mucocele and aneurysmal bone cyst. Benign bone tumors (4) comprised of giant cell tumor, fibrous dysplasia, chondroma, and osteoblastoma. Other benign tumors included lipoma (6), hemangioma (5), schwannoma (2), meningioma (1), pleomorphic adenoma (1), sebaceous adenoma (1) and other skin adnexal tumors (3). Malignant epithelial tumors (24; 15.2%) included squamous cell carcinoma (10), basal cell carcinoma (5), poorly differentiated carcinoma (4) and metastatic carcinoma (5). Two cases of chordoma and one case each of dermatofibrosarcoma pertuberance and hemangiopericytoma were seen. Sarcomas included sarcoma, not otherwise specified (4), rhabdomyosarcoma (3), osteosarcoma (2), chondrosarcoma (2), leiomyosarcoma (1), malignant fibrous histiocytoma (1), fibrosarcoma (1) and malignant peripheral nerve sheath tumor (1). There were cases of malignant small round cell tumor (11), non-Hodgkin lymphoma (3), plasmacytoma (2) and malignant melanoma (2). A variety of non-neoplastic and neoplastic conditions can involve the sinonasal region. FNAC is a reliable diagnostic procedure in a good number of cases, especially in the light of clinico-radiological data. Copyright © 2011 S. Karger AG, Basel.

  13. [Leather dusts and cancerogenic effects].

    PubMed

    Cirla, Piero Emanuele

    2012-01-01

    Work exposure to carcinogenic chemicals in the shoe industry is still debated owing to continuous technological developments. A possible causal role in sino-nasal cancer development was attributed to the leather dusts basing on epidemiologic studies. Nevertheless, convincing conclusions regarding toxicodinamic-involved processes are actually missing. An hypothesis pointing on tannins toxic action shows insufficient and contrasting data. A cancerogenic risk seems to be attributable for workers engaged in the whole process of shoe industry.

  14. RGS21, A Regulator of Taste and Mucociliary Clearance?

    PubMed Central

    Kimple, Adam J.; Garland, Alaina L.; Cohen, Staci P.; Setola, Vincent; Willard, Francis S.; Zielinski, Thomas; Lowery, Robert G.; Tarran, Robert; Siderovski, David P.

    2014-01-01

    Objectives/Hypothesis: Motile cilia of airway epithelial cells help to expel harmful inhaled material. Activation of bitterant-responsive G protein-coupled receptors (GPCRs) is believed to potentiate cilia beat frequency and mucociliary clearance. In this study, we investigated whether regulator of G protein signaling-21 (RGS21) has the potential to modulate signaling pathways connected to airway mucociliary clearance, given that RGS proteins modulate GPCR signaling by acting as GTPase-accelerating proteins (GAPs) for the Gα subunits of heterotrimeric G proteins. Study Design: This is a pilot investigation to determine if RGS21, a potential tastant specific RGS gene, is expressed in sinonasal mucosa, and to determine its specific Gα substrate using in vitro biochemical assays with purified proteins. Methods: Rgs21 expression in sinonasal mucosa was determined using quantitative, real-time PCR and a transgenic mouse expressing RFP from the Rgs21 promoter. Rgs21 was cloned, over-expressed, and purified using multistep protein chromatography. Biochemical and biophysical assays were used to determine if RGS21 could bind and accelerate the hydrolysis of GTP on heterotrimeric Gα subunits. Results: Rgs21 was expressed in sinonasal mucosa and lingual epithelium. Purified recombinant protein directly bound and accelerated GTP hydrolysis on Gα subunits. Conclusions: Rgs21 is expressed in sinonasal mucosa, is amenable to purification as a recombinant protein, and can bind to Gαi/o/q subunits. Furthermore, RGS21 can accelerate the hydrolysis rate of GTP on Gαi subunits. This provides evidence that RGS21 may be a negative regulator of bitterant responses. Future studies will be needed to determine the physiological role of this protein in mucociliary clearance. PMID:23908053

  15. Maxillofacial esthesioneuroblastoma: A diagnostic complexity

    PubMed Central

    Raj, G Shyam; Rao, Guttikonda Venkateswara; Kumar, Manchikatla Praveen; Sudheerkanth, Kondamari

    2016-01-01

    Esthesioneuroblastoma is a rare malignant tumor of the sinonasal tract. Oral and maxillofacial pathologists rarely encounter this tumor in their daily practice. Because of their complex anatomic location, non-specific symptoms, varied histomorphology and unfamiliarity, most of the times, the tumor is diagnosed as benign tumor and thereby conservative treatment results in multiple recurrences. A recurrent case of esthesioneuroblastoma in a 24-year-old female patient describing the clinical, histopathological and immunohistochemical features along with differential diagnosis is discussed. PMID:27601839

  16. Maxillofacial esthesioneuroblastoma: A diagnostic complexity.

    PubMed

    Raj, G Shyam; Rao, Guttikonda Venkateswara; Kumar, Manchikatla Praveen; Sudheerkanth, Kondamari

    2016-01-01

    Esthesioneuroblastoma is a rare malignant tumor of the sinonasal tract. Oral and maxillofacial pathologists rarely encounter this tumor in their daily practice. Because of their complex anatomic location, non-specific symptoms, varied histomorphology and unfamiliarity, most of the times, the tumor is diagnosed as benign tumor and thereby conservative treatment results in multiple recurrences. A recurrent case of esthesioneuroblastoma in a 24-year-old female patient describing the clinical, histopathological and immunohistochemical features along with differential diagnosis is discussed.

  17. Impact of nasal symptoms on the evaluation of asthma control.

    PubMed

    Huang, Chien-Chia; Chang, Po-Hung; Wu, Pei-Wen; Wang, Chun-Hua; Fu, Chia-Hsiang; Huang, Chi-Che; Tseng, Hsiao-Jung; Lee, Ta-Jen

    2017-02-01

    The united airways concept suggests that patients with asthma typically exhibit parallel inflammation in the upper airway. The resulting nasal symptoms should reduce quality of life and substantially affect the evaluation of asthma control among these patients. This study aimed to assess the association of nasal symptoms with the evaluation of asthma control.Fifty-eight patients with asthma and persistent nasal symptoms were prospectively recruited for evaluations of their sinonasal symptoms and asthma control in a cross-sectional study from August 2013 to June 2016. Participants underwent thorough nasal endoscopy, sinus computed tomography, pulmonary function testing, the asthma control test (ACT), and the Sino-Nasal Outcome Test-22 (SNOT-22) questionnaires to evaluate their asthma control and sinonasal symptoms.There was a significant association between ACT and SNOT-22 scores. Among patients with asthma and chronic rhinosinusitis, ACT scores were closely related to the symptoms of cough, post-nasal discharge, dizziness, waking up at night, absence of a good night's sleep, and waking up tired. Among patients with asthma and chronic rhinitis, the forced expiratory volume in 1 second was closely related to the symptoms of needing to blow nose, runny nose, and cough. Patients with emergency clinic visits during the previous 3 months had relatively high SNOT-22 scores, especially for the symptoms of sneezing, runny nose, nasal blockage, cough, and dizziness.Sinonasal symptom severity was closely associated with measured asthma control status among patients with asthma and persistent nasal symptoms. Therefore, upper and lower airway inflammations should be considered and treated simultaneously.

  18. Fungus Ball in Concha Bullosa: A Rare Case with Anosmia

    PubMed Central

    Özkırıs, Mahmut; Kapusuz, Zeliha; Seçkın, Selda; Saydam, Levent

    2013-01-01

    Concha bullosa is the pneumatization of the concha and is one of the most common variations of the sinonasal anatomy. The histopathological changes caused by the infections which arise from the impaired aeration of conchal cavity are frequently found. Fungus ball of the nasal cavity is an extremely rare, fungal infection with only three cases reported previously. In this paper, we present the fourth fungus ball case which developed within a concha bullosa and presented with anosmia. PMID:23936708

  19. Equine nasal and paranasal sinus tumours: part 2: a contribution of 28 case reports.

    PubMed

    Dixon, P M; Head, K W

    1999-05-01

    The clinical and pathological findings of 28 cases (27 horses, 1 donkey) of equid sinonasal tumours examined at the Edinburgh Veterinary School are presented and include: seven cases of squamous cell carcinoma (SCC); five adenocarcinomas; three undifferentiated carcinomas; two adenomas; five fibro-osseous and bone tumours; and single cases of ameloblastoma, fibroma, fibrosarcoma, undifferentiated sarcoma, melanoma and lymphosarcoma. The median ages of animals affected with epithelial, and fibro-osseous/bone tumours were 14 and 4 years, respectively. Unilateral purulent or mucopurulent nasal discharge (81% of cases) and gross facial swellings (82% of cases) were the most common presenting signs with sinonasal tumours, with epistaxis recorded in just 23% of cases. Radiology and endoscopy were the most useful ancillary diagnostic techniques. The maxillary area was the most common site of tumour origin, and only three cases were definitively identified as originating in the nasal cavity. Four of the maxillary SCC lesions originated within the nasal cavities or maxillary sinuses, while two originated in the oral cavity. Fourteen of 15 carcinomas, but only two of the 13 remaining tumours, spread to other sites in the head. Only three cases of sinonasal tumour had lymph node metastases, and none had distant metastases. In the long term, surgical treatment with seven malignant tumours was unsuccessful (6 months median survival post-operatively), but was successful with four out of five benign tumours (no regrowth at a median of 4 years post-operatively).

  20. Safety of a preservative-free acidified saline nasal spray: a randomized, double-blind, placebo-controlled, crossover clinical trial.

    PubMed

    Ryan, William R; Hwang, Peter H

    2010-11-01

    To determine the safety and tolerance of a buffered preservative-free acidified solution as an alternative to standard chemical preservatives to prevent microbial contamination of saline nasal spray. Randomized, double-blind, placebo-controlled, crossover clinical trial. Tertiary academic medical center. Healthy volunteers with no history or signs of sinonasal disease. Twenty volunteers used a buffered preservative-free acidified solution in a saline nasal spray and a benzalkonium chloride-containing saline nasal spray for 1 week each, separated by a 1-week washout period. At study enrollment and after using each nasal spray solution, participants completed a visual analog scale symptom questionnaire and the 20-Item Sino-Nasal Outcome Test and underwent nasal endoscopic examination, which was graded using a modified Lund-Kennedy scoring system. At the end of each test period, the contents of each nasal spray bottle were cultured for microorganism growth. All 20 participants completed the study. Four participants who developed upper respiratory tract illnesses during the study period were excluded from secondary analyses. No differences were observed in specific sinonasal symptoms or nasal endoscopy findings after use of either nasal spray. No nasal spray solutions from either group had any microorganism growth. In a short-term study with a small sample size, a preservative-free acidified solution seems to be safe and well tolerated, while maintaining sterility in a multiple-dose applicator without use of chemical preservatives.

  1. Anterolateral corridor approach to the infratemporal fossa and central skull base in maxillectomy: rationale and technical aspects.

    PubMed

    McMahon, Jeremy D; Crowther, John; Taylor, William M; Wong, Ling Siew; Paterson, Tom; Devine, John; Wales, Craig; MacIver, Colin

    2015-11-01

    We describe the technical aspects and report our clinical experience of a surgical approach to the infratemporal fossa that aims to reduce local recurrence after operations for cancer of the posterior maxilla. We tested the technique by operating on 3 cadavers and then used the approach in 16 patients who had posterolateral maxillectomy for disease that arose on the maxillary alveolus or junction of the hard and soft palate (maxillary group), and in 19 who had resection of the masticatory compartment and central skull base for advanced sinonasal cancer (sinonasal group). Early proximal ligation of the maxillary artery was achieved in all but one of the 35 patients. Access to the infratemporal fossa enabled division of the pterygoid muscles and pterygoid processes under direct vision in all cases. No patient in the maxillary group had local recurrence at median follow up of 36 months. Four patients (21%) in the sinonasal group had local recurrence at median follow up of 27 months. Secondary haemorrhage from the cavernous segment of the internal carotid artery resulted in the only perioperative death. The anterolateral corridor approach enables controlled resection of tumours that extend into the masticatory compartment. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  2. The link between chronic rhinosinusitis and asthma

    PubMed Central

    Huang, Chien-Chia; Wang, Chun-Hua; Fu, Chia-Hsiang; Huang, Chi-Che; Chang, Po-Hung; Chen, I-Wei; Lee, Ta-Jen

    2016-01-01

    Abstract Treatments for chronic rhinosinusitis (CRS) and asthma can affect both conditions, based on the united airway concept. This study aimed to evaluate the link between CRS and asthma, based on disease-specific quality of life measures. We performed a prospective cohort study to investigate the correlations between results from CRS- and asthma-specific questionnaires. Thirty-two patients with asthma and CRS were evaluated before and after undergoing nasal surgery at a tertiary medical center. There were significant correlations between the results from the Asthma Control Test (ACT) and the Sino-Nasal Outcome Test-22, as well as between the results of the ACT and Rhinoconjunctivitis Quality of Life Questionnaire, at both the preoperative and 3-month postoperative evaluations (P < 0.01). Moreover, nasal surgery improved the sinonasal symptoms, asthma control, and pulmonary function (P < 0.01). Increasingly severe sinonasal symptoms of CRS were associated with poor asthma control. Therefore, CRS and asthma should be considered and treated as common airway diseases. PMID:27495032

  3. PubMed Central

    Jurlina, M.; Passali, D.; Passali, F.M.; Mladina, R.

    2016-01-01

    SUMMARY Ossifying fibroma is a benign fibro-osseous tumour that rarely involves the ethmoid sinuses and orbit. It is classified as a benign fibroosseous lesion, a term that is synonymous with a variety of lesions reported in the literature. Recurrence rate with deleterious effects in cases of extramandibular ossifying fibroma is the impetus for open en bloc resection of the tumour. Continuously evolving techniques in endonasal endoscopic sinus surgery has rendered resection of large benign sinonasal and cephalonasal tumours possible. The authors report a case of ossifying fibroma involving the ethmoid sinus, orbit and anterior skull base in a 65-year-old previously healthy woman completely resected by endonasal endoscopic sinus surgery. The patient was free from postoperative complications and was dismissed from hospital on the sixth postoperative day. At present, the patient is disease-free at a regular five-year postoperative follow-up. Endonasal endoscopic resection of sinonasal ossifying fibromas is an excellent therapeutic option when performed by a surgeon experienced in endoscopic sinonasal surgery. The advantages of an endonasal endoscopic approach include direct visualization, enhanced visibility and magnification resulting in decreased intraoperative and postoperative morbidity. Aesthetic outcome is excellent in the absence of facial scars. PMID:27196080

  4. Using Maslow’s Hierarchy of Needs to Identify Indicators of Potential Mass Migration Events

    DTIC Science & Technology

    2016-03-23

    Grado. " Fertility trends, excess mortality, and the Great Irish Famine." Demography, November, 1986, 543. Ireland IrelandGermany Germany Germany Italy...Statistics. Washington D.C.: U.S. Department of Homeland Security, 2010. Boyle, Phelim and Grado, Cormac. " Fertility trends, excess mortality, and the

  5. [Atypical ganglioglioma with BRAF V600E mutation: a case report and review of the literature].

    PubMed

    Martinez-Ricarte, F; Martinez-Saez, E; Cicuendez, M; Cordero, E; Auger, C; Toledo, M; Radoi, A; Sahuquillo, J

    2016-05-16

    Introduccion. Los gangliogliomas son tumores raros que afectan a pacientes jovenes, aparecen predominantemente en el lobulo temporal y suelen comenzar con crisis epilepticas. Histologicamente corresponden a un grado I de malignidad, con una forma anaplasica catalogada como de grado III en la clasificacion de la Organizacion Mundial de la Salud (OMS) de 2007. Sin embargo, existen tumores que no cumplen criterios de uno u otro grado y que presentan claras diferencias pronosticas respecto a los de grado I. Estos tumores corresponderian a gangliogliomas atipicos (grado II), no contemplados en la citada clasificacion. Desde el punto de vista molecular, la alteracion mas conocida en los gangliogliomas es la mutacion de BRAF V600E, que confiere peor pronostico a la lesion. La posibilidad de utilizar tratamientos dirigidos a esta proteina mutada otorga una especial relevancia a esta alteracion. Caso clinico. Varon de 21 años, intervenido de un ganglioglioma en dos ocasiones, en el que el examen neuropatologico objetivo caracteristicas histologicas compatibles con un grado de malignidad intermedio (grado II) con mutacion positiva a BRAF. Conclusiones. El caso presentado, junto con los descritos previamente en la bibliografia, reabre las controversias sobre la definicion de los gangliogliomas en la clasificacion de la OMS de 2007, y apoya el hecho de que la proxima clasificacion de la OMS deberia volver a incluir los gangliogliomas atipicos (grado II) e integrar posibles mutaciones geneticas y alteraciones moleculares.

  6. Smoking: An independent risk factor for lost productivity in chronic rhinosinusitis.

    PubMed

    Campbell, Adam P; Hoehle, Lloyd P; Phillips, Katie M; Caradonna, David S; Gray, Stacey T; Sedaghat, Ahmad R

    2017-08-01

    Chronic rhinosinusitis (CRS) is associated with a significant loss of patient productivity that costs billions of dollars every year. Smoking is associated with worsening sinonasal symptoms, but its effect on lost productivity in CRS patients has yet to be described. Therefore, we sought to determine the association between smoking and productivity in patients with CRS. Prospective cross-sectional cohort study of 140 patients with CRS. Sinonasal symptom severity was measured using the 22-item Sino-Nasal Outcomes Test. Lost productivity was assessed by asking participants how many days of work and/or school they missed in the last 3 months due to CRS. Associations were sought between lost productivity and smoking. Participants missed a mean of 3.0 days (standard deviation = 12.8 days) of work or school due to CRS. Having any history of smoking was associated with 6 days of lost productivity due to CRS (adjusted β = 6.20, 95% confidence interval [CI]: 0.64 to 11.77, P = .031). Although the number of active smokers in our study cohort was very small (N = 6), we performed a univariate association between smoking status, considering former smokers and active smokers separately, and found that active smoking (β = 11.75, 95% CI: 2.11 to 21.40, P = .018) had a much larger impact on CRS-related productivity loss than that experienced by former smokers (β = 4.45, 95% CI: -0.32 to 9.23, P = .070). Smoking (likely driven by active smoking) is independently associated with missed days of work or school in patients with CRS. Further study is needed to determine whether interventions directed at smoking may impact CRS-related productivity loss. 2c Laryngoscope, 127:1742-1745, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  7. IL-33-responsive innate lymphoid cells are an important source of IL-13 in chronic rhinosinusitis with nasal polyps.

    PubMed

    Shaw, Joanne L; Fakhri, Samer; Citardi, Martin J; Porter, Paul C; Corry, David B; Kheradmand, Farrah; Liu, Yong-Jun; Luong, Amber

    2013-08-15

    Chronic rhinosinusitis (CRS) without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP) are associated with Th1 and Th2 cytokine polarization, respectively; however, the pathophysiology of CRS remains unclear. The importance of innate lymphoid cells in Th2-mediated inflammatory disease has not been clearly defined. The objective of this study was to investigate the role of the epithelial cell-derived cytokine IL-33 and IL-33-responsive innate lymphoid cells in the pathophysiology of CRS. Relative gene expression was evaluated using quantitative real-time polymerase chain reaction. Innate lymphoid cells in inflamed ethmoid sinus mucosa from patients with CRSsNP and CRSwNP were characterized using flow cytometry. Cytokine production from lymphoid cells isolated from inflamed mucosa of patients with CRS was examined using ELISA and intracellular cytokine staining. Elevated expression of ST2, the ligand-binding chain of the IL-33 receptor, was observed in inflamed sinonasal mucosa from CRSwNP compared with CRSsNP and healthy control subjects. An increased percentage of innate lymphoid cells was observed in inflamed sinonasal mucosa from CRSwNP compared with CRSsNP. ST2(+) innate lymphoid cells are a consistent source of IL-13 in response to IL-33 stimulation. Significant induction of IL-33 was observed in epithelial cells derived from patients with CRSwNP compared with patients with CRSsNP in response to stimulation with Aspergillus fumigatus extract. These data suggest a role for sinonasal epithelial cell-derived IL-33 and an IL-33-responsive innate lymphoid cell population in the pathophysiology of CRSwNP demonstrating the functional importance of innate lymphoid cells in Th2-mediated inflammatory disease.

  8. Flavones modulate respiratory epithelial innate immunity: Anti-inflammatory effects and activation of the T2R14 receptor.

    PubMed

    Hariri, Benjamin M; McMahon, Derek B; Chen, Bei; Freund, Jenna R; Mansfield, Corrine J; Doghramji, Laurel J; Adappa, Nithin D; Palmer, James N; Kennedy, David W; Reed, Danielle R; Jiang, Peihua; Lee, Robert J

    2017-05-19

    Chronic rhinosinusitis has a significant impact on patient quality of life, creates billions of dollars of annual healthcare costs, and accounts for ∼20% of adult antibiotic prescriptions in the United States. Because of the rise of resistant microorganisms, there is a critical need to better understand how to stimulate and/or enhance innate immune responses as a therapeutic modality to treat respiratory infections. We recently identified bitter taste receptors (taste family type 2 receptors, or T2Rs) as important regulators of sinonasal immune responses and potentially important therapeutic targets. Here, we examined the immunomodulatory potential of flavones, a class of flavonoids previously demonstrated to have antibacterial and anti-inflammatory effects. Some flavones are also T2R agonists. We found that several flavones inhibit Muc5AC and inducible NOS up-regulation as well as cytokine release in primary and cultured airway cells in response to several inflammatory stimuli. This occurs at least partly through inhibition of protein kinase C and receptor tyrosine kinase activity. We also demonstrate that sinonasal ciliated epithelial cells express T2R14, which closely co-localizes (<7 nm) with the T2R38 isoform. Heterologously expressed T2R14 responds to multiple flavones. These flavones also activate T2R14-driven calcium signals in primary cells that activate nitric oxide production to increase ciliary beating and mucociliary clearance. TAS2R38 polymorphisms encode functional (PAV: proline, alanine, and valine at positions 49, 262, and 296, respectively) or non-functional (AVI: alanine, valine, isoleucine at positions 49, 262, and 296, respectively) T2R38. Our data demonstrate that T2R14 in sinonasal cilia is a potential therapeutic target for upper respiratory infections and that flavones may have clinical potential as topical therapeutics, particularly in T2R38 AVI/AVI individuals. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.

  9. Inverting papilloma of the temporal bone: Report of four new cases and systematic review of the literature.

    PubMed

    Carlson, Matthew L; Sweeney, Alex D; Modest, Mara C; Van Gompel, Jamie J; Haynes, David S; Neff, Brian A

    2015-11-01

    Inverting papillomas (IPs) are benign locally invasive tumors that most commonly present within the sinonasal cavity. Temporal bone involvement is exceedingly rare, with fewer than 30 cases reported within the English literature to date. Case series and systematic review of the literature. Four consecutive subjects with temporal bone inverting papilloma (TBIP) were treated, and an additional 28 previously published cases were identified in the literature. Main outcome measures were disease presentation, diagnostic evaluation, management strategy, and outcome. A total of 32 cases were analyzed. The median age at diagnosis was 54 years (mean 54.1; range 19-81 years). Nineteen (59%) patients had synchronous or metachronous sinonasal IP, whereas 13 (41%) had isolated temporal bone disease without sinus involvement. Over half of the patients undergoing microsurgical resection experienced at least one recurrence. Compared to patients with a history of sinus IP, subjects with primary TBIP were younger at time of presentation (44 vs. 58 years; P=0.012); were more commonly female (62% vs. 32%; P=0.15); and were less likely to have intracranial spread (8% vs. 26%; P=0.36), cranial neuropathy (8% vs. 26%; P=0.36), human papillomavirus positivity (11% vs. 57%; P=0.11), or associated carcinoma (0% vs. 47%; P=0.004). Inverting papilloma of the lateral skull base is rare and can pose a significant therapeutic challenge. Primary lesions of the temporal bone appear to follow a less aggressive clinical course when compared to those arising in association with sinonasal disease. Gross total resection is the preferred method of treatment, when feasible, given the high rate of recurrence with subtotal resection and risk of associated malignancy. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  10. Schneiderian papillomas: Comparative review of exophytic, oncocytic, and inverted types

    PubMed Central

    Vira, Darshni; Suh, Jeffrey D.; Bhuta, Sunita; Wang, Marilene B.

    2013-01-01

    Background: Sinonasal papillomas are benign epithelial neoplasms arising from Schneiderian mucosa. The three subtypes, exophytic, oncocytic, and inverted (inverted papilloma [IP]), should be distinguished from one another histopathologically. This study (1) highlights the histopathological and clinical differences between the Schneiderian papilloma subtypes and (2) identifies clinical features that potentially predict papilloma subtypes. Methods: A retrospective review was performed of patients with Schneiderian papillomas over an 11-year period. Results: Seventy patients with sinonasal papillomas who underwent sinus surgery were identified. There were 50 (71%) male and 20 (29%) female subjects diagnosed at an average age of 53 years (range, 13–80 years). Exophytic (n = 25), oncocytic (n = 9), and IP (n = 37) were identified. IP was associated with transformation into squamous cell carcinoma in three (8%) cases and dysplasia in three (8%) cases. Neither oncocytic nor exophytic subtypes were associated with dysplasia or malignancy. On multivariate analysis of potential predictors of papilloma subtype, history of chronic rhinosinusitis (CRS) and location of papilloma were significantly associated with papilloma subtype. Using classification and regression tree model, papilloma subtypes can be predicted based on presence or absence of CRS and papilloma location with nominal 82.4% accuracy. Conclusion: The inverted and exophytic type are the most common sinonasal papillomas, with the inverted type having an 8% rate of malignant transformation in this study. In contrast, the oncocytic type was not associated with dysplasia or malignancy in our series despite reports in the literature indicating malignant potential. History of CRS and papilloma location can provide clues to the histological subtype, which is important for surgical planning and patient counseling. PMID:23883810

  11. [Occupational exposure to wood dust. Health effects and exposure limit values].

    PubMed

    Carton, M; Goldberg, M; Luce, D

    2002-04-01

    This article presents a review of the health effects of occupational exposure to wood dusts and of the data that could be used for setting occupational exposure limits for this nuisance. The causal role of wood dust in the onset of sinonasal cancers is solidly established by numerous epidemiological studies, and the magnitude of the risk is particularly high for adenocarcinoma induced by exposure to hardwood dust. However, no current data allows to rule out the carcinogenic role of softwood dusts and, in the view of protecting the health of the workers, it does not seem relevant to distinguish these two types of wood. Various impairments of the lung function have been frequently associated with exposure to both 'allergenic' and 'non-allergenic' wood dusts and may occur at very low concentrations. According to the SUMER 94 and CAREX studies, about 200 000 workers are currently exposed to wood dusts in France (about 1% of the working population between 1990 and 1994). When taking into account full professional careers, the percentage of workers having been occupationally exposed can be estimated to be about 15% for men and 5% for women. Measurements performed in France between 1987 and 2000 show that exposure levels are high, about 50% of the samplings being over 1mg/m(3) (actual TWA in France). Although the studies present limits, particularly for the quantitative assessment of individual exposure levels, it seems that nonmalignant effects are susceptible to arise at the level of 1mg/m(3); a limit value of 0.5mg/m(3) would credibly allow to protect exposed workers from most of the risks of nonmalignant pulmonary effects. However, it is impossible to assure that this value will avoid the induction of sinonasal cancer, even if this level is certainly lower than the levels to which the cases of sinonasal cancers published in the literature were exposed.

  12. Mixed T Helper Cell Signatures In Chronic Rhinosinusitis with and without Polyps

    PubMed Central

    Derycke, Lara; Eyerich, Stefanie; Van Crombruggen, Koen; Pérez-Novo, Claudina; Holtappels, Gabriele; Deruyck, Natalie; Gevaert, Philippe; Bachert, Claus

    2014-01-01

    In chronic rhinosinusitis (CRS) different phenotypes have been reported based on cytokine profile and inflammatory cell patterns. The aim of this study was to characterize the intracytoplasmatic cytokines ofTcells infiltrating theinflamed sinonasal mucosa. Methods Infiltrated T cells and tissue homogenates from sinonasal mucosal samples of 7 healthy subjects, 9 patients with CRS without nasal polyp (CRSsNP), 15 with CRS with nasal polyps (CRSwNP) and 5cystic fibrosis patients (CF-NP) were analyzed for cytokine expression using flow cytometry and multiplex analysis respectively. Intracytoplasmic cytokinesin T cells were analyzed after stimulation of nasal polyps with Staphylococcus aureus enterotoxin B for 24 hours. Results The number of T cellsper total living cells was significantly higher in patients with CRSwNP vs. CRSsNP and controls. 85% of the CD4+ Tcells showed to be memory T cells. The effector T cells present in all tissues have apredominantTh1 phenotype. Only in CRSwNP, a significantfraction of T cellsproduced the Th2 cytokinesIL-4 and IL-5, while nasal polyps from CF patients were characterized by a higher CD4/CD8 T cell ratio and an increased number of Th17 cells. 24 h stimulation with SEB resulted in a significant induction of CD4+ T cells producing IL-10 (Tr1 cells). Conclusion T cell cytokine patternsin healthy and inflamed sinonasal mucosa revealed that Th2 cells (IL-4 and IL-5 producing cells) are significantly increased in CRSwNP mucosal inflammation. Exposure to SEB stimulates Tr1 cellsthat may contribute to the Th2 bias in CRSwNP. PMID:24911279

  13. Equine paranasal sinus disease: a long-term study of 200 cases (1997-2009): treatments and long-term results of treatments.

    PubMed

    Dixon, P M; Parkin, T D; Collins, N; Hawkes, C; Townsend, N; Tremaine, W H; Fisher, G; Ealey, R; Barakzai, S Z

    2012-05-01

    There is limited objective information available on the treatment and the long-term response to treatment of the different types of equine sinus disease. To document the treatments and long-term response to these treatments in 200 cases of equine sinus disease (1997-2009). The treatments of horses affected with subacute primary sinusitis (n = 52); chronic primary sinusitis (n = 37); dental sinusitis (n = 40); sinus cyst (n = 26); traumatic (n = 13); dental-related oromaxillary fistula (n = 8); sinus neoplasia (n = 10); mycotic sinus disease (n = 7); and intrasinus progressive ethmoid haematoma (n = 7) and the long-term response to these treatments were retrospectively reviewed. Treatments evolved throughout the study and latterly were as conservative as possible, including sinoscopic lavage and standing sinusotomy, with a maxillary sinusotomy approach preferred for the mainly mature horses treated in this study. Removal of intrasinus inspissated pus, including transendoscopically (by sinusotomy and via existing sinonasal fistulae), was the main treatment for chronic primary sinusitis and sinonasal fistulation was seldom performed latterly. Attempted oral extraction of infected cheek teeth, even if unsuccessful, facilitated subsequent dental repulsion, resulting in few post operative problems. Sinus cyst removal carried an excellent prognosis. Except for cases of sinus neoplasia (only 22% cured), an excellent long-term response to treatment (91% fully cured, 7% partially cured) was obtained for all other types of sinus disease following a median of one treatment. More conservative treatments, including removal of intrasinus inspissated pus by sinoscopy, pre-existing sinonasal fistula or sinusotomy, are effective for chronic primary sinus disease. Standing sinusotomy, mainly using a small maxillary site, was suitable for most cases of sinus disease in mature horses. © 2011 EVJ Ltd.

  14. Analysis of computed tomography features of fungal sinusitis and their correlation with nasal endoscopy and histopathology findings.

    PubMed

    Gupta, Kamini; Saggar, Kavita

    2014-01-01

    The purpose of this study was to analyze the computed tomography (CT) features of fungal sinusitis and to correlate them with nasal endoscopy and histopathological findings. Our study included 16 patients of either sex and any age group who presented in the otorhinolaryngology clinic at our hospital and had evidence of definite sinonasal disease on clinical evaluation. Multidetector CT was carried out on Somatom definition AS + 128 slice CT Machine by Siemens Germany Ltd. Axial sections were performed with the plane of data acquisition parallel to the hard palate and slice thickness of 3 mm, reconstructions at 0.75 mm in coronal and sagittal planes. Scanning parameters included 190 mA S, 120 KV and tube rotation time of 0.5 s. Provisional CT diagnosis was made in all cases and correlated with nasal endoscopy and histopathological findings. Out of total 16 patients, 12 showed immunocompromised status and had infection with mucormycosis. Out of 12, 9 patients (75%) showed extension of disease beyond the sinonasal cavities and 4 (33.3%) showed evidence of bone destruction. All patients with candidiasis showed soft-tissue attenuation with hyperdense areas on CT scan. Nearly, 66.6% patients with aspergillosis showed soft-tissue attenuation with hyperdense areas and expansion of sinonasal cavities. Fifteen patients (93%) were proved to be of fungal sinusitis on histopathology. One patient of non-specific granulomatous infection showed bone destruction and mimicked fungal sinusitis on CT. In the present study, fungal sinusitis could be correctly diagnosed on CT with high accuracy. Thus, understanding the different CT findings of fungal sinusitis allows the radiologist to play a crucial role in the diagnosis and prompt treatment.

  15. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Mucosal Melanomas.

    PubMed

    Williams, Michelle D

    2017-03-01

    The updated edition of The World Health Organization Classification of Tumours of the Head and Neck includes discussions on mucosal melanoma of both the sinonasal and oral cavity. Since the prior edition, sinonasal origin is now recognized as the most common site of occurrence of mucosal melanoma in the head and neck (66%) with oral cavity representing 25% of cases. Histologic features of mucosal melanomas vary widely from spindled, epithelioid, and pleomorphic to rhabdoid, plasmacytoid and undifferentiated. Additionally, mucosal melanomas are commonly amelanotic (or minimal pigmentation) (~50%) leading to overlapping features and diagnostic challenges in differentiating mucosal melanomas from other small cell/undifferentiated sinonasal tumors. Since the last edition, formal staging of head and neck mucosal melanomas was added to the American Joint Committee on Cancer entities, though the traditional histologic features that have prognostic significance in cutaneous melanomas fail to stratify mucosal melanomas (i.e. tumor thickness, ulceration). Interestingly, while melanomas of all sites are a malignancy derived from melanocytes, mucosal melanomas are now recognized to have distinct molecular alterations compared to cutaneous or uveal melanomas. BRAF V600E mutations are rare (<6%) in mucosally derived melanomas compared to a rate of 50% in cutaneous melanomas. CD117 (C-Kit) mutations are the most common alteration encountered (~25%) in mucosal sites with potential therapeutic targetability. The recognition of the distinct genetic changes in this subgroup of melanomas means that therapy advances in cutaneous melanomas may not translate to head and neck mucosal melanomas and clinical trials specific to this subgroup of patients are needed.

  16. Alterations of nasal mucociliary clearance in association with HIV infection and the effect of guaifenesin therapy.

    PubMed

    Rosen, Elizabeth J; Calhoun, Karen H

    2005-01-01

    To determine if human immunodeficiency virus (HIV) infection is associated with a prolonged mucociliary clearance time (MCT) and to evaluate the effect of guaifenesin on MCT in HIV+ patients. A cross-sectional study comparing HIV+ and HIV- volunteers followed by a prospective, randomized, double-blind, placebo-controlled study of HIV+ patients before and after guaifenesin treatment. Twenty-five HIV+ patients and 29 HIV- controls were enrolled and MCT was measured using the saccharin method. A separate group of 20 HIV+ patients participated in the second arm of the study and underwent saccharin testing before and after a 3-week course of guaifenesin or placebo. All study participants completed a medical history questionnaire, a sinonasal symptom (SNOT-16) survey, and were examined with both anterior rhinoscopy and rigid nasal endoscopy. There was a significant difference (P < .002) in the MCT between the HIV+ group (13.3 +/- SD 7.5 minutes) and the HIV- controls (9.2 +/- SD 3.9 minutes). The difference in MCT between the guaifenesin and placebo groups did not reach statistical significance (P >.05). The HIV+ group had a higher SNOT-16 score compared to HIV- controls (21.1 vs. 7.4, P < .001). Guaifenesin therapy in HIV+ patients led to a significant improvement in the SNOT-16 score (P < .05). Compared to HIV- controls, HIV+ patients have a prolonged MCT and more sinonasal symptoms as indicated by a higher SNOT-16 score. Guaifenesin therapy was associated with improved SNOT-16 scores, although there was not a detectable improvement in MCT. Use of guaifenesin in HIV+ patients with sinonasal disease may lead to improved patient perception of quality of life.

  17. Impact of endoscopic endonasal pituitary surgery on nasal airway patency

    PubMed Central

    Jalessi, Maryam; Farhadi, Mohammad; Asghari, Alimohamad; Hosseini, Maryam; Amini, Elahe; Pousti, Seyyed Behzad

    2016-01-01

    Background: Nose is used as a corridor in endoscopic endonasal transsphenoidal approach (EETSA) for pituitary adenoma. Thus, it may affect the nasal airway patency, function and sinonasal-related quality of life. The aim of this study is to objectively and subjectively evaluate these effects. Methods: In this prospective study, 43 patients with pituitary adenoma who were candidates for EETSA from March 2012 to October 2013 were enrolled. The patients were evaluated preoperatively using acoustic rhinometry and rhinomanometry (with/without the use of decongestant drops) and asked to complete the 22-Item Sinonasal Outcome Test (SNOT-22) questionnaire. The tests were repeated at one and three months postoperatively. The preoperative data were compared with the first and second postoperative ones using paired-sample t-test. Results: Without the use of decongestant drops, the total airway resistance increased significantly (p=0.016), and the nasal airflow decreased significantly (p=0.031) in the first postoperative evaluation. However, in the 3rd postoperative month, the difference was not significant. With the use of decongestant drops, the objective parameters showed no significant changes compared to preoperative data even at the first evaluation. The SNOT- 22 scores also did not differ significantly in 1st and 3rd postoperative months. The first postoperative SNOT-22 showed a strong correlation with the second minimal cross-sectional area on simultaneous evaluation, and with the preoperative total airway resistance. Conclusion: EETSA has a transient adverse effect on the nasal patency that quickly improves, making it a safe approach for the sinonasal system. Rhinomanometry is the most sensitive test for detecting these nasal functional changes objectively. PMID:27493923

  18. Secondary cleft rhinoplasty: impact on self-esteem and quality of life.

    PubMed

    Roosenboom, Jasmien; Hellings, Peter W; Picavet, Valerie A; Prokopakis, Emmanuel P; Antonis, Yasmine; Schoenaers, Joseph; Vander Poorten, Vincent; Claes, Peter; Hens, Greet

    2014-12-01

    Rhinoplasty is one of the most challenging facial plastic procedures. Although patient satisfaction is the real outcome parameter in rhinoplasty, most authors have studied objective outcomes evaluated by professionals. The purpose of this study was to determine patient satisfaction after rhinoplasty in patients born with a cleft lip compared with outcome assessment by professionals, and to assess the impact of the procedure on appearance-related distress and generic quality of life. Patient evaluation of the nose was performed before and 1 year after secondary cleft rhinoplasty (n = 33) using a visual analogue scale for nasal function and shape, and the Rhinoplasty Outcome Evaluation. General sinonasal complaints were evaluated using the Sino-Nasal Outcome Test. Appearance-related psychological distress was measured using the Derriford Appearance Scale. The Sheehan Disability Scale evaluated quality of life. Aesthetic outcome was evaluated by scoring of preoperative and postoperative photographs by two independent surgeons. One year postoperatively, patients showed significantly higher visual analogue scale scores for nasal shape (p < 0.0001) and function (p = 0.005) and higher Rhinoplasty Outcome Evaluation (p < 0.0001) scores. Correspondingly, Sino-Nasal Outcome Test scores were lower (p = 0.006). The appearance-related psychological distress was lower (p < 0.0001), and the generic quality of life was increased after rhinoplasty (p = 0.01). No correlation was found between patient outcome evaluation and surgeons' scores. There is high patient satisfaction at 12 months after secondary cleft rhinoplasty, resulting in a significant improvement of self-esteem and generic quality of life.

  19. Chlorogenic Acid Activates CFTR-Mediated Cl- Secretion in Mice and Humans: Therapeutic Implications for Chronic Rhinosinusitis

    PubMed Central

    Illing, Elisa; Cho, Do-Yeon; Zhang, Shaoyan; Skinner, Daniel F.; Dunlap, Quinn A.; Sorscher, Eric J.; Woodworth, Bradford A.

    2016-01-01

    Objectives Salubrious effects of the green coffee bean are purportedly secondary to high concentrations of chlorogenic acid. Chlorogenic acid has a molecular structure similar to bioflavonoids that activate transepithelial Cl- transport in sinonasal epithelia. In contrast to flavonoids, the drug is freely soluble in water. The objective of this study is to evaluate the Cl- secretory capability of chlorogenic acid and its potential as a therapeutic activator of mucus clearance in sinus disease. Study Design Basic research Setting Laboratory Subjects and Methods Chlorogenic acid was tested on primary murine nasal septal epithelial(MNSE)[CFTR+/+ and transgenic CFTR-/-] and human sinonasal epithelial(HSNE)[CFTR+/+ and F508del/F508del] cultures under pharmacologic conditions in Ussing chambers to evaluate effects on transepithelial Cl- transport. Cellular cAMP, phosphorylation of the CFTR regulatory domain(R-D), and CFTR mRNA transcription were also measured. Results Chlorogenic acid stimulated transepithelial Cl- secretion [(change in short-circuit current(ΔISC=μA/cm2)] in MNSE(13.1+/-0.9 vs. 0.1+/-0.1, p<0.05) and HSNE(34.3+/-0.9 vs. 0.0+/-0.1, p<0.05). The drug had a long duration until peak effect at 15-30 minutes after application. Significant inhibition with INH-172, as well as absent stimulation in cultures lacking functional CFTR, suggests effects are dependent on CFTR-mediated pathways. However, the absence of elevated cellular cAMP and phosphorylation the CFTR R-D indicates chlorogenic acid does not work through a PKA-dependent mechanism. Conclusion Chlorogenic acid is a water soluble agent that promotes CFTR-mediated Cl- transport in mouse and human sinonasal epithelium. Translating activators of mucociliary transport to clinical use provides a new therapeutic approach to sinus disease. Further in vivo evaluation is planned. PMID:26019132

  20. Chlorogenic Acid Activates CFTR-Mediated Cl- Secretion in Mice and Humans: Therapeutic Implications for Chronic Rhinosinusitis.

    PubMed

    Illing, Elisa A; Cho, Do-Yeon; Zhang, Shaoyan; Skinner, Daniel F; Dunlap, Quinn A; Sorscher, Eric J; Woodworth, Bradford A

    2015-08-01

    Salubrious effects of the green coffee bean are purportedly secondary to high concentrations of chlorogenic acid. Chlorogenic acid has a molecular structure similar to bioflavonoids that activate transepithelial Cl(-) transport in sinonasal epithelia. In contrast to flavonoids, the drug is freely soluble in water. The objective of this study is to evaluate the Cl(-) secretory capability of chlorogenic acid and its potential as a therapeutic activator of mucus clearance in sinus disease. Basic research. Laboratory. Chlorogenic acid was tested on primary murine nasal septal epithelial (MNSE) (CFTR(+/+) and transgenic CFTR(-/-)) and human sinonasal epithelial (HSNE) (CFTR(+/+) and F508del/F508del) cultures under pharmacologic conditions in Ussing chambers to evaluate effects on transepithelial Cl(-) transport. Cellular cyclic adenosine monophosphate (cAMP), phosphorylation of the CFTR regulatory domain (R-D), and CFTR mRNA transcription were also measured. Chlorogenic acid stimulated transepithelial Cl(-) secretion (change in short-circuit current [ΔISC = µA/cm(2)]) in MNSE (13.1 ± 0.9 vs 0.1 ± 0.1; P < .05) and HSNE (34.3 ± 0.9 vs 0.0 ± 0.1; P < .05). The drug had a long duration until peak effect at 15 to 30 minutes after application. Significant inhibition with INH-172 as well as absent stimulation in cultures lacking functional CFTR suggest effects are dependent on CFTR-mediated pathways. However, the absence of elevated cellular cAMP and phosphorylation the CFTR R-D indicates chlorogenic acid does not work through a PKA-dependent mechanism. Chlorogenic acid is a water-soluble agent that promotes CFTR-mediated Cl(-) transport in mouse and human sinonasal epithelium. Translating activators of mucociliary transport to clinical use provides a new therapeutic approach to sinus disease. Further in vivo evaluation is planned. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  1. IL-33–Responsive Innate Lymphoid Cells Are an Important Source of IL-13 in Chronic Rhinosinusitis with Nasal Polyps

    PubMed Central

    Shaw, Joanne L.; Fakhri, Samer; Citardi, Martin J.; Porter, Paul C.; Corry, David B.; Kheradmand, Farrah; Liu, Yong-Jun

    2013-01-01

    Rationale: Chronic rhinosinusitis (CRS) without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP) are associated with Th1 and Th2 cytokine polarization, respectively; however, the pathophysiology of CRS remains unclear. The importance of innate lymphoid cells in Th2-mediated inflammatory disease has not been clearly defined. Objectives: The objective of this study was to investigate the role of the epithelial cell–derived cytokine IL-33 and IL-33–responsive innate lymphoid cells in the pathophysiology of CRS. Methods: Relative gene expression was evaluated using quantitative real-time polymerase chain reaction. Innate lymphoid cells in inflamed ethmoid sinus mucosa from patients with CRSsNP and CRSwNP were characterized using flow cytometry. Cytokine production from lymphoid cells isolated from inflamed mucosa of patients with CRS was examined using ELISA and intracellular cytokine staining. Measurements and Main Results: Elevated expression of ST2, the ligand-binding chain of the IL-33 receptor, was observed in inflamed sinonasal mucosa from CRSwNP compared with CRSsNP and healthy control subjects. An increased percentage of innate lymphoid cells was observed in inflamed sinonasal mucosa from CRSwNP compared with CRSsNP. ST2+ innate lymphoid cells are a consistent source of IL-13 in response to IL-33 stimulation. Significant induction of IL-33 was observed in epithelial cells derived from patients with CRSwNP compared with patients with CRSsNP in response to stimulation with Aspergillus fumigatus extract. Conclusions: These data suggest a role for sinonasal epithelial cell–derived IL-33 and an IL-33–responsive innate lymphoid cell population in the pathophysiology of CRSwNP demonstrating the functional importance of innate lymphoid cells in Th2-mediated inflammatory disease. PMID:23805875

  2. Features of mesenchymal transition in the airway epithelium from chronic rhinosinusitis.

    PubMed

    Hupin, C; Gohy, S; Bouzin, C; Lecocq, M; Polette, M; Pilette, C

    2014-11-01

    Chronic rhinosinusitis (CRS) defines a group of disorders characterized by persistent inflammation of the sinonasal tract. Epithelial changes and structural remodelling are present, but whether epithelial differentiation is altered remains uncertain. To evaluate the differentiation state of the sinonasal epithelium in CRS, sinonasal biopsies from patients with CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP), or with allergic rhinitis (AR), as compared to controls, were processed by immunohistochemistry and RT-qPCR for terminal differentiation (E-cadherin, high molecular weight cytokeratins (Hmw CK) and CK5, vimentin) and lineage differentiation (ß-tubulin IV+ ciliated cells, MUC5AC+ goblet cells, p63 + basal cells). Findings were correlated with subepithelial fibrosis and clinical CT score. Expression of E-cadherin was decreased at protein and mRNA levels in CRSwNP and CRSsNP, as compared to controls. Staining for Hmw CKs was also reduced in CRSwNP and CRSsNP, and CK5 mRNA was decreased in CRSwNP. These features were not due to changes in lineage specification, but associated with increases in vimentin-expressing epithelial cells. In addition, vimentin expression correlated with the basement membrane thickening and with CT score, as well as with tissue eosinophils. Features of epithelial dedifferentiation towards a mesenchymal phenotype are observed in CRSwNP and CRSsNP and correlate with airway fibrosis and inflammation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Paranasal Rosai-Dorfman Disease with Osseous Destruction

    PubMed Central

    Koempel, Jeffrey A.

    2017-01-01

    Rosai-Dorfman disease is a rare histiocytic proliferative disorder of unknown etiology typically characterized by cervical lymphadenopathy. Extranodal involvement often manifests in the head and neck region. We present a 10-year-old male who presented to our hospital with left epiphora from an aggressive paranasal mass invading the left orbit with osseous destruction. The mass was surgically biopsied and debulked with histopathological examination revealing Rosai-Dorfman disease. Although rarely found in the sinuses, Rosai-Dorfman disease should be considered when evaluating sinonasal masses. PMID:28321353

  4. Environmental factors that can affect sleep and breathing: allergies.

    PubMed

    Kent, David T; Soose, Ryan J

    2014-09-01

    Allergic rhinitis and associated symptomatic nasal obstruction negatively affect sleep through a variety of mechanisms and may contribute to persistent symptoms and poor adherence with medical device therapy for sleep apnea. A history of sinonasal symptoms, particularly those that occur at night or in the supine position, is the cornerstone of the medical evaluation. Further research into the relationship between allergic rhinitis and sleep disturbance would benefit from improved anatomic and pathophysiologic phenotyping as well as more advanced outcome measures such as spectral electroencephalogram analysis or other polysomnography variables beyond the apnea-hypopnea index.

  5. Sinocutaneous Fistula Formation After Forehead Recontouring Surgery for Transgender Patients.

    PubMed

    Lam, Kent; Ho, Tang; Yao, William C

    2017-01-30

    Forehead recontouring is a common part of facial feminization surgery. The procedure, which alters the shape and structure of the frontal bone, is regarded as safe and well tolerated by patients. The occurrence of delayed complications, however, is much less understood. The authors describe a patient involving the development of a sinocutaneous fistula as a delayed complication of forehead recontouring surgery. The clinical presentation and management of this patient are discussed. As facial feminization surgery expands as a cosmetic option for patients who desire more feminine facial features, practitioners should recognize the potential risk of sinonasal complications associated with forehead recontouring surgery.

  6. Aspirin-Exacerbated Respiratory Disease.

    PubMed

    Walgama, Evan S; Hwang, Peter H

    2017-02-01

    Aspirin-exacerbated respiratory disease (AERD) is characterized by the triad of asthma, sinonasal polyposis, and aspirin intolerance. The hallmark of the disease is baseline overproduction of cysteinyl leukotrienes via the 5-lipoxygenase pathway, exacerbated by ingestion of aspirin. Patients with AERD have high rates of recidivistic polyposis following sinus surgery, although the improvement in quality of life following surgery is similar to aspirin-tolerant patients. The diagnosis is secured by a positive aspirin provocation test, usually administered by a medical allergist. Aspirin therapy is a unique treatment consideration for patients with AERD.

  7. Rapidly fluctuating anosmia: A clinical sign for unilateral smell impairment.

    PubMed

    Negoias, Simona; Friedrich, Hergen; Caversaccio, Marco D; Landis, Basile N

    2016-02-01

    Reports about fluctuating olfactory deficits are rare, as are reports of unilateral olfactory loss. We present a case of unilateral anosmia with contralateral normosmia, presenting as rapidly fluctuating anosmia. The olfactory fluctuation occurred in sync with the average nasal cycle duration. Examination after nasal decongestion, formal smell testing, and imaging revealed unilateral, left-sided anosmia of sinonasal cause, with right-sided normosmia. We hypothesize that the nasal cycle induced transient anosmia when blocking the normosmic side. Fluctuating olfactory deficits might hide a unilateral olfactory loss and require additional unilateral testing and thorough workup. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  8. Advanced cocaine-related necrotising sinusitis presenting with restrictive ophthalmolplegia.

    PubMed

    Lascaratos, Gerassimos; McHugh, James; McCarthy, Karon; Bunting, Howard

    2016-06-01

    We report a case of bilateral infero-medial orbital wall destruction, associated with loss of sinonasal architecture. The patient presented with intermittent horizontal diplopia following an acute on chronic infective sinusitis. Eight months previously the patient had developed a midline hard palate fistula for which a palatine prosthesis had been fitted. The broad differential diagnosis is discussed, though in this patient chronic cocaine abuse was identified as the underlying aetiology. Eye movement restriction worsened progressively with bilateral inflammation around the medial and inferior rectus muscles. Attempts to resolve the recurring cycle of sinus infection and inflammation by palatal fistula closure failed despite augmented techniques mobilising flaps from both nasal and palatal sides.

  9. Genetic and Immune Dysregulation in Chronic Rhinosinusitis.

    PubMed

    Halderman, Ashleigh; Lane, Andrew P

    2017-02-01

    Chronic rhinosinusitis (CRS) is a prevalent condition that is heterogeneous in disease characteristics and multifactorial in cause. Although sinonasal mucosal inflammation in CRS is often either reversible or well-managed medically and surgically, a significant proportion of patients has a refractory form of CRS despite maximal therapy. Two of the several described factors thought to contribute to disease recalcitrance are genetic influences and dysfunction of the host immune system. Current evidence for a genetic basis of CRS is reviewed, as it pertains to putative abnormalities in innate and adaptive immune function. The role of systemic immunodeficiencies in refractory CRS is discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. PubMed Central

    Battaglia, P.; Turri-Zanoni, M.; F., De Bernardi; Karligkiotis, A.; Leone, F.; Castelnuovo, P.

    2016-01-01

    SUMMARY Over the past decade surgery for sinonasal malignancies encroaching into the anterior skull base (ASB) has evolved from open craniofacial resection to the use of minimally invasive transnasal endoscopic approaches. Using these techniques, ASB reconstruction is most often performed in a multilayer fashion with autologous free grafts (fascia lata or iliotibial tract) which leads to the production of abundant nasal crusting in the postoperative months and discomfort for patients. In carefully selected cases, we propose harvesting a flap from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries (Septal Flip Flap, SFF), which can be rotated to resurface the ASB defect. The exclusion criteria for using the SFF were as follows: cases where the tumour extended to both ethmoid complexes; cases where there was nasal septum or planum spheno-ethmoidalis involvement by the disease; cases of sinonasal malignant tumour with multifocal histology. In our tertiary care referral centre, skull base reconstruction using the SFF was performed in four patients; one was affected by ethmoidal teratocarcinosarcoma, one by persistence of sinonasal undifferentiated carcinoma after radio-chemotherapy, another by olfactory cleft esthesioneuroblastoma and the fourth by ethmoidal squamous cell carcinoma. Successful skull base reconstruction was obtained in all four cases without any intra- or post-operative complications. Post-operatively, nasal crusting was significantly reduced with faster healing of the surgical cavity. No recurrences of disease have been observed after a mean follow-up of 15 months. The SFF can be considered as a safe and effective technique for ASB reconstruction with high success rates similar to those obtained with other pedicled flaps. This flap also ensured a faster healing process with reduction of nasal crusting and improvement in the quality of life of patients in the postoperative period. This technique

  11. Systemic and Odontogenic Etiologies in Chronic Rhinosinusitis.

    PubMed

    Kuan, Edward C; Suh, Jeffrey D

    2017-02-01

    Systemic and odontogenic etiologies of chronic rhinosinusitis, although rare, are an integral consideration in the comprehensive management of patients with sinonasal disease. Proper knowledge and timely recognition of each disease process, with referrals to appropriate consultants, will facilitate treatment, because many of these conditions require both local and systemic therapy. In some instances, medical therapy plays a pivotal role, with surgery being a supplemental treatment technique. We review the most commonly encountered systemic etiologies of chronic rhinosinusitis and odontogenic sinusitis, including clinical presentation, diagnosis, management, and treatment outcomes.

  12. Hemangioma of the sphenoid and ethmoid sinuses: two case reports.

    PubMed

    Kilde, John D; Rhee, John S; Balla, Andre A; Smith, Michelle M; Smith, Timothy L

    2003-03-01

    Hemangiomas of the paranasal sinuses are rare, particularly those of the sphenoid and ethmoid sinuses. Although imaging of the sinuses is key to determining the extent of involvement, the diagnosis is based on the lesion's histologic appearance. Obtaining an adequate biopsy can be difficult in light of the risk of bleeding and the relative inaccessibility of lesions in this region. These obstacles can make the diagnosis and management of these lesions particularly challenging. We describe two new cases of sinonasal hemangioma--one in the ethmoid sinus and one in the ethmoid and sphenoid sinuses--and we discuss the diagnostic and therapeutic interventions that are needed to manage these lesions.

  13. Evaluation and management of "sinus headache" in the otolaryngology practice.

    PubMed

    Patel, Zara M; Setzen, Michael; Poetker, David M; DelGaudio, John M

    2014-04-01

    Patients, primary care doctors, neurologists and otolaryngologists often have differing views on what is truly causing headache in the sinonasal region. This review discusses common primary headache diagnoses that can masquerade as "sinus headache" or "rhinogenic headache," such as migraine, trigeminal neuralgia, tension-type headache, temporomandibular joint dysfunction, giant cell arteritis (also known as temporal arteritis) and medication overuse headache, as well as the trigeminal autonomic cephalalgias, including cluster headache, paroxysmal hemicrania, and hemicrania continua. Diagnostic criteria are discussed and evidence outlined that allows physicians to make better clinical diagnoses and point patients toward better treatment options.

  14. Inverted papilloma of the palate with malignant transformation

    PubMed Central

    Halimi, Monireh; Aghbali, Amirala; Emamverdizadeh, Parya; Talesh, Koroush Taheri

    2012-01-01

    The inverted papilloma is a unilateral sinonasal benign tumor which is characterized by aggressive local invasion, high recurrence rate, and transformation into malignancy. The etiology of inverted papilloma is still unknown. Possible causes include allergy, chronic sinusitis, occupational exposure to dusts and aerosols, tobacco, and viral infections. Treatment is complete surgical excision and close postoperative follow-up is necessary. Here we report a case of inverted papilloma arising from the hard palate with malignant transformation in a 41-year-old female. Clinical and histological features and treatment are discussed with the review of literature. PMID:22923908

  15. Esthesioneuroblastoma: a contemporary review of diagnosis and management.

    PubMed

    Bak, Matthew; Wein, Richard O

    2012-12-01

    Esthesioneuroblastoma (ENB) is a rare malignancy, representing only 3% to 6% of all sinonasal malignancies. A wide array of treatment options for ENB have been described in the literature, but prospective clinical trials are absent given the tumor's rarity and natural history. Delay in diagnosis leading to an initial advanced stage of presentation is common secondary to the clinically hidden primary site at the anterior skull base. This article presents data from the current body of literature and reviews the advocated roles for surgery, radiation therapy and chemotherapy.

  16. Endoscopic Management of Esthesioneuroblastoma.

    PubMed

    Roxbury, Christopher R; Ishii, Masaru; Gallia, Gary L; Reh, Douglas D

    2016-02-01

    Esthesioneuroblastoma is a rare malignant tumor of sinonasal origin. These tumors typically present with unilateral nasal obstruction and epistaxis, and diagnosis is confirmed on biopsy. Over the past 15 years, significant advances have been made in endoscopic technology and techniques that have made this tumor amenable to expanded endonasal resection. There is growing evidence supporting the feasibility of safe and effective resection of esthesioneuroblastoma via an expanded endonasal approach. This article outlines a technique for endoscopic resection of esthesioneuroblastoma and reviews the current literature on esthesioneuroblastoma with emphasis on outcomes after endoscopic resection of these malignant tumors.

  17. Prognosis and biology in esthesioneuroblastoma: the emerging role of Hyams grading system.

    PubMed

    Saade, Rami E; Hanna, Ehab Y; Bell, Diana

    2015-01-01

    Esthesioneuroblastoma is a sinonasal tumor with distinct clinicopathologic features, multiple facets, and a spectrum of behavior. Characterization of this disease is challenging, and clinically, several staging systems have been used with no consensus on a single scheme. Recently, the Hyams histological grading system has emerged as a promising prognostication tool that offers an added value to stage. This review addresses prognosis and biology in esthesioneuroblastoma. More specifically, we sought to present a critical appraisal on the value of each of these stratification systems, stage vs. grade, in identifying risk groups and guiding management.

  18. CT & CBCT imaging: assessment of the orbits.

    PubMed

    Hatcher, David C

    2012-11-01

    The orbits can be visualized easily on routine or customized protocols for computed tomography (CT) or cone beam CT (CBCT) scans. Detailed orbital investigations are best performed with 3-dimensional imaging methods. CT scans are preferred for visualizing the osseous orbital anatomy and fissures while magnetic resonance imaging is preferred for evaluating tumors and inflammation. CBCT provides high-resolution anatomic data of the sinonasal spaces, airway, soft tissue surfaces, and bones but does not provide much detail within the soft tissues. This article discusses CBCT imaging of the orbits, osseous anatomy of the orbits, and CBCT investigation of selected orbital pathosis.

  19. Distinctive Head and Neck Bone and Soft Tissue Neoplasms.

    PubMed

    Purgina, Bibianna; Lai, Chi K

    2017-03-01

    Benign and malignant primary bone and soft tissue lesions of the head and neck are rare. The uncommon nature of these tumors, combined with the complex anatomy of the head and neck, pose diagnostic challenges to pathologists. This article describes the pertinent clinical, radiographic, and pathologic features of selected bone and soft tissue tumors involving the head and neck region, including angiofibroma, glomangiopericytoma, rhabdomyosarcoma, biphenotypic sinonasal sarcoma, chordoma, chondrosarcoma, and osteosarcoma. Emphasis is placed on key diagnostic pitfalls, differential diagnosis, and the importance of correlating clinical and radiographic information, particularly for tumors involving bone.

  20. Robotics in Sinus and Skull Base Surgery.

    PubMed

    Rangarajan, Sanjeet; Hachem, Ralph Abi; Ozer, Enver; Beer-Furlan, Andre; Prevedello, Daniel; Carrau, Ricardo L

    2017-06-01

    Transoral robotic surgery (TORS) has been proven to be safe and to yield acceptable oncological and functional outcomes for surgery of the oropharynx, hypopharynx, supraglottis, and glottis. TORS has been successful at reducing morbidity, improving quality of life, and providing access to areas that previously required mandibulotomy or other more radical approaches in the past. This has changed the paradigm of management of tumors in these anatomic locations. In this article, the authors review the recent literature discussing the role of robotic surgery in managing sinonasal and skull base pathology and discuss its current advantages and limitations. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Feline aspergillosis.

    PubMed

    Barrs, Vanessa R; Talbot, Jessica J

    2014-01-01

    Feline aspergillosis includes sinonasal aspergillosis (SNA), sino-orbital aspergillosis (SOA), other focal invasive forms, and disseminated disease. SOA is an invasive mycosis that is being increasingly recognized, and is most commonly caused by a recently discovered pathogen Aspergillus felis. SNA can be invasive or noninvasive and is most commonly caused by Aspergillus fumigatus and Aspergillus niger. Molecular methods are required to correctly identify the fungi that cause SNA and SOA. SNA has a favorable prognosis with treatment, whereas the prognosis for SOA remains poor.

  2. The New Kids on the Block: Recently Characterized Soft Tissue Tumors.

    PubMed

    Riddle, Nicole N; Gardner, Jerad M

    2015-09-01

    Soft tissue pathology is a rapidly changing subspecialty. New entities are described relatively often, and new molecular findings for soft tissue tumors are reported in the literature almost every month. This article summarizes the major features and diagnostic approach to several recently characterized entities: superficial CD34-positive fibroblastic tumor, fibrosarcoma-like lipomatous neoplasm, angiofibroma of soft tissue, low-grade sinonasal sarcoma with neural and myogenic features, malignant gastrointestinal neuroectodermal tumor, hemosiderotic fibrolipomatous tumor, and epithelioid inflammatory myofibroblastic sarcoma. Additionally, the article also provides a summary table of recent molecular findings in soft tissue tumors.

  3. Chondrosarcoma of the nasal septum

    PubMed Central

    Bahgat, Mohammed; Bahgat, Yassin; Bahgat, Ahmed; Elwany, Yasmine

    2012-01-01

    Chondrosarcoma of the nasal septum is a rare malignancy. When it occurs, early diagnosis is difficult because patients generally present with common, non-specific sinonasal complaints. This is the report of a 62-year-old woman who presented with a 1-month history of nasal obstruction, headache and anosmia. Nasal endoscopy showed a nasal mass obstructing both nasal cavities not separable from the septum. A wedge biopsy of the nasal mass was taken. Histopathology was suggestive of chondrosarcoma. The tumour was removed by an endoscopic approach. The clinical presentation, diagnosis and treatment of this case as well as a review of the literature are discussed. PMID:22669930

  4. Standing equine sinus surgery.

    PubMed

    Barakzai, Safia Z; Dixon, Padraic M

    2014-04-01

    Trephination of the equine sinuses is a common surgical procedure in sedated standing horses. Standing sinus flap surgery has become increasingly popular in equine referral hospitals and offers several advantages over sinusotomy performed under general anesthesia, including reduced patient-associated risks and costs; less intraoperative hemorrhage, allowing better visualization of the operative site; and allows surgeons to take their time. Other minimally invasive surgical procedures include sinoscopic surgery, balloon sinuplasty, and transnasal laser sinonasal fenestration. Despite the procedure used, appropriate indications for surgery, good patient selection, and familiarity with regional anatomy and surgical techniques are imperative for good results. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Imaging for head and neck cancer.

    PubMed

    Abraham, Jesty

    2015-07-01

    Imaging is an essential tool in the management of head and neck cancer. Oral, oropharyngeal, laryngeal, and hypopharyngeal lesions are initially imaged with computed tomography (CT) because it allows rapid image acquisition and reduces artifacts related to respiration and swallowing, which can degrade image quality and limit evaluation. Sinonasal, nasopharyngeal, and salivary gland tumors are better approached with MRI because it allows for better delineation of tumor extent. PET/CT is usually reserved for advanced disease to evaluate for distant metastatic disease and posttreatment residual and recurrent disease. Imaging is best used in combination with expert clinical and physical examination. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Entropía de la información: una herramienta útil

    NASA Astrophysics Data System (ADS)

    Cincotta, P.

    En este trabajo se presenta una muy breve introducción al concepto de Entropía de la Información y se muestran distintas aplicaciones de una misma técnica para estudiar problemas tan variados como la determinación de periodicidad en una serie de tiempo arbitraria o de estimar el grado de caoticidad de una trayectoria en un sistema dinámico de N grados de libertad.

  7. Airflow in the Human Nasal Passage and Sinuses of Chronic Rhinosinusitis Subjects.

    PubMed

    Kumar, Haribalan; Jain, Ravi; Douglas, Richard G; Tawhai, Merryn H

    2016-01-01

    Endoscopic surgery is performed on patients with chronic inflammatory disease of the paranasal sinuses to improve sinus ventilation. Little is known about how sinus surgery affects sinonasal airflow. In this study nasal passage geometry was reconstructed from computed tomographic imaging from healthy normal, pre-operative, and post-operative subjects. Transient air flow through the nasal passage during calm breathing was simulated. Subject-specific differences in ventilation of the nasal passage were observed. Velocity magnitude at ostium was different between left and right airway. In FESS, airflow in post-surgical subjects, airflow at the maxillary sinus ostium was upto ten times higher during inspiration. In a Lothrop procedure, airflow at the frontal sinus ostium can be upto four times higher during inspiration. In both post-operative subjects, airflow at ostium was not quasi-steady. The subject-specific effect (of surgery) on sinonasal interaction evaluated through airflow simulations may have important consequences for pre- and post-surgical assessment and surgical planning, and design for improvement of the delivery efficiency of nasal therapeutics.

  8. A review of the implications of computational fluid dynamic studies on nasal airflow and physiology.

    PubMed

    Leong, S C; Chen, X B; Lee, H P; Wang, D Y

    2010-06-01

    Computational fluid dynamics has been adapted to studying nasal aerodynamics. To review current literature on CFD studies, with an emphasis on normal nasal airflow, the impact of sinonasal pathology on airflow, and implications on nasal physiology. The objective is to provide the rhinologists with a greater understanding of nasal airflow and how symptomatology of sinonasal disease may be explained via CFD simulations. The nasal valve region redirects inspiratory airstreams over the inferior turbinate in a high turbulent kinetic energy, which is important in heat and moisture exchange. The bulk of airflow occurs in the common meatus with small streams traversing the olfactory groove, increasing during sniffing. Septal deviation and enlarged inferior turbinate causes redistribution of airflow, changes in intranasal pressure and increased turbulence. High velocity airflow and wall shear stress at the septal perforation causes desiccation and mucosal damage. The airflow within an atrophic nasal cavity is predominantly laminar with minimal contact with nasal mucosa. The inferior turbinate is an important organ for air conditioning and preservation during surgery is highlighted. Despite some limitations of CFD simulations, this technology has improved understanding of the complex nasal anatomy and the implications of disease and surgery on physiology.

  9. A computational analysis of nasal vestibule morphologic variabilities on nasal function.

    PubMed

    Ramprasad, Vaibhav H; Frank-Ito, Dennis O

    2016-02-08

    Although advances in computational modeling have led to increased understanding of nasal airflow, not much is known about the effects of normal sinonasal anatomic variabilities on nasal function. In this study, three distinct variations in the human nasal vestibule airspace that have not been previously described were identified. Computational fluid dynamics modeling of nasal airflow profile in each identified variation of nasal vestibule phenotype was conducted to assess the role of these phenotypes on nasal physiology. Three-dimensional reconstructions of the nasal geometry in sixteen subjects with normal radiographic sinonasal images were created and each respective unilateral nasal cavity was classified as Notched, Standard, or Elongated phenotype based nasal vestibule morphology. Steady state, laminar and incompressible flow simulations were performed in the nasal geometries under physiological, pressure-driven conditions with constant inspiratory pressure. Results showed that at localized regions of the unilateral nasal cavity, average resistance was significantly different among nasal vestibule phenotypes. However, global comparison from nostril to choana showed that average resistance was not significantly different across phenotypes; suggesting that with normal anatomic variations, the nose has a natural compensatory mechanism that modulates localized airflow in order to achieve a desired amount of global airflow. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Airflow in the Human Nasal Passage and Sinuses of Chronic Rhinosinusitis Subjects

    PubMed Central

    Kumar, Haribalan; Jain, Ravi; Douglas, Richard G.; Tawhai, Merryn H.

    2016-01-01

    Endoscopic surgery is performed on patients with chronic inflammatory disease of the paranasal sinuses to improve sinus ventilation. Little is known about how sinus surgery affects sinonasal airflow. In this study nasal passage geometry was reconstructed from computed tomographic imaging from healthy normal, pre-operative, and post-operative subjects. Transient air flow through the nasal passage during calm breathing was simulated. Subject-specific differences in ventilation of the nasal passage were observed. Velocity magnitude at ostium was different between left and right airway. In FESS, airflow in post-surgical subjects, airflow at the maxillary sinus ostium was upto ten times higher during inspiration. In a Lothrop procedure, airflow at the frontal sinus ostium can be upto four times higher during inspiration. In both post-operative subjects, airflow at ostium was not quasi-steady. The subject-specific effect (of surgery) on sinonasal interaction evaluated through airflow simulations may have important consequences for pre- and post-surgical assessment and surgical planning, and design for improvement of the delivery efficiency of nasal therapeutics. PMID:27249219

  11. Sleep quality improves with endoscopic sinus surgery in patients with chronic rhinosinusitis and nasal polyposis.

    PubMed

    Värendh, M; Johannisson, A; Hrubos-Strøm, H; Andersson, M

    2017-03-01

    Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) is a chronic disease that has a major impact on generic and disease-specific quality of life. Little is known about the influence of CRSwNP on sleep and what effect surgery for CRSwNP has on sleep quality. The aim of the study was to investigate sleep quality in patients with CRSwNP before and after endoscopic surgery. Forty-two patients filled out four validated sleep questionnaires and one sino/nasal, disease specific quality of life questionnaire before surgery and three months later. A healthy control group filled out the same questionnaires at baseline and after three months. An impact on sleep patterns was found in all sleep questionnaires and surgery clearly improved the quality of sleep. The Sino-nasal outcome test sum score decreased from median 51,5 to 26,5. Epworth sleepiness scale showed a decline in score from score 7.5 to 6.0. Surgery also reduced the risk for obstructive sleep apnoea in 13 patients evaluated by the Berlin Questionnaire and Multivariable Apnea Prediction Index. Patients with CRSwNP had impaired sleep quality, daytime sleepiness, nasal patency, and risk for sleep apnea, all of which improved after corrective surgery.

  12. Intensity-modulated radiation therapy for malignancies of the nasal cavity and paranasal sinuses

    SciTech Connect

    Daly, Megan E.; Chen, Allen M. . E-mail: allenmchen@yahoo.com; Bucci, M. Kara; El-Sayed, Ivan; Xia Ping; Kaplan, Michael J.; Eisele, David W.

    2007-01-01

    Purpose: To report the clinical outcome of patients treated with intensity-modulated radiation therapy (IMRT) for malignancies of the nasal cavity and paranasal sinuses. Methods and Materials: Between 1998 and 2004, 36 patients with malignancies of the sinonasal region were treated with IMRT. Thirty-two patients (89%) were treated in the postoperative setting after gross total resection. Treatment plans were designed to provide a dose of 70 Gy to 95% or more of the gross tumor volume (GTV) and 60 Gy to 95% or more of the clinical tumor volume (CTV) while sparing neighboring critical structures including the optic chiasm, optic nerves, eyes, and brainstem. The primary sites were: 13 ethmoid sinus, 10 maxillary sinus, 7 nasal cavity, and 6 other. Histology was: 12 squamous cell, 7 esthesioneuroblastoma, 5 adenoid cystic, 5 undifferentiated, 5 adenocarcinoma, and 2 other. Median follow-up was 51 months among surviving patients (range, 9-82 months). Results: The 2-year and 5-year estimates of local control were 62% and 58%, respectively. One patient developed isolated distant metastasis, and none developed isolated regional failure. The 5-year rates of disease-free and overall survival were 55% and 45%, respectively. The incidence of ocular toxicity was minimal with no patients reporting decreased vision. Late complications included xerophthalmia (1 patient), lacrimal stenosis (1 patient), and cataract (1 patient). Conclusion: Although IMRT for malignancies of the sinonasal region does not appear to lead to significant improvements in disease control, the low incidence of complications is encouraging.

  13. Gnathic and peripheral ameloblastomas lack human papillomavirus DNA.

    PubMed

    Verduin, Lindsey; Bishop, Justin; Mills, Stacey E

    2015-10-01

    Human papillomavirus (HPV) has been associated with a variety of head and neck neoplasms, including squamous cell carcinomas and Schneiderian papillomas. Ameloblastomas can arise from either the gnathic bones or peripheral soft tissues. Peripheral sinonasal ameloblastomas share clinical features with Schneiderian papillomas. A small number of reports have described detection of HPV DNA within ameloblastomas. However, Most of these cases was reported in the 1990s, used the polymerase chain reaction technique, and only examined gnathic tumors. The current study was designed to determine whether low- or high-risk HPV DNA could be detected in gnathic or peripheral ameloblastomas using in situ hybridization. Twenty-nine examples of gnathic osseous and peripheral head and neck ameloblastomas were obtained from the authors' archives (University of Virginia and the Johns Hopkins Hospital). High-risk HPV DNA was not detected in any of the 29 tumors analyzed. Low-risk HPV DNA was identified in only 1 tumor, which was peripheral in origin, and from an immunocompromised patient. We believe that the HPV in this case represents a background "passenger" infection. This study demonstrates that HPV of either high- or low-risk subtypes is unlikely to play a role in the pathogenesis of sinonasal ameloblastomas. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Nasal Irrigation: An Imprecisely Defined Medical Procedure

    PubMed Central

    Principi, Nicola; Esposito, Susanna

    2017-01-01

    Nasal irrigation (NI) is an old practice of upper respiratory tract care that likely originated in the Ayurvedic medical tradition. It is used alone or in association with other therapies in several conditions—including chronic rhinosinusitis and allergic rhinitis—and to treat and prevent upper respiratory tract infections, especially in children. However, despite it being largely prescribed in everyday clinical practice, NI is not included or is only briefly mentioned by experts in the guidelines for treatment of upper respiratory tract diseases. In this review, present knowledge about NI and its relevance in clinical practice is discussed to assist physicians in understanding the available evidence and the potential use of this medical intervention. Analysis of the literature showed that NI seems to be effective in the treatment of several acute and chronic sinonasal conditions. However, although in recent years several new studies have been performed, most of the studies that have evaluated NI have relevant methodologic problems. Only multicenter studies enrolling a great number of subjects can solve the problem of the real relevance of NI, and these studies are urgently needed. Methods for performing NI have to be standardized to determine which solutions, devices and durations of treatment are adequate to obtain favorable results. This seems particularly important for children that suffer a great number of sinonasal problems and might benefit significantly from an inexpensive and simple preventive and therapeutic measure such as NI. PMID:28492494

  15. Schneiderian-Type Papilloma of the Middle Ear: A Review of the Literature.

    PubMed

    Schaefer, Nathan; Chong, Jessica; Griffin, Aaron; Little, Andrew; Gochee, Peter; Dixon, Natalie

    2015-06-01

    Schneiderian-type papilloma of the middle ear is a rare finding. We present a 46-year-old Aboriginal man with a large tympanic membrane perforation and a Schneiderian-type papilloma filling the middle ear. The aim of this study is to familiarize clinicians with this uncommon disease through discussion of its clinical presentation, diagnostic considerations and management. A search of English-language peer-reviewed literature was undertaken using the key words "Schneiderian-type papilloma," "inverted papilloma," and "middle ear." A total of 29 cases (including the present case) of Schneiderian-type papilloma involving the middle ear were reviewed. Common presenting symptoms include hearing loss, otalgia, and otorrhea. Middle ear disease is associated with higher rates of recurrence and malignant transformation than its sinonasal counterpart. Radical surgical resection is the only curative treatment. Schneiderian-type papilloma is a benign, but locally aggressive, epithelial neoplasm most commonly arising in the sinonasal tract. Whilst involvement of the middle ear is extremely rare, knowledge of this condition is important due to its propensity to recur and the high rate of malignant transformation.

  16. Long-Term Safety of Topical Bacteriophage Application to the Frontal Sinus Region

    PubMed Central

    Drilling, Amanda J.; Ooi, Mian L.; Miljkovic, Dijana; James, Craig; Speck, Peter; Vreugde, Sarah; Clark, Jason; Wormald, Peter-John

    2017-01-01

    Background: Staphylococcus aureus biofilms contribute negatively to a number of chronic conditions, including chronic rhinosinusitis (CRS). With the inherent tolerance of biofilm-bound bacteria to antibiotics and the global problem of bacterial antibiotic resistance, the need to develop novel therapeutics is paramount. Phage therapy has previously shown promise in treating sinonasal S. aureus biofilms. Methods: This study investigates the long term (20 days) safety of topical sinonasal flushes with bacteriophage suspensions. The bacteriophage cocktail NOV012 against S. aureus selected for this work contains two highly characterized and different phages, P68 and K710. Host range was assessed against S. aureus strains isolated from CRS patients using agar spot tests. NOV012 was applied topically to the frontal sinus region of sheep, twice daily for 20 days. General sheep wellbeing, mucosal structural changes and inflammatory load were assessed to determine safety of NOV012 application. Results: NOV012 could lyse 52/61 (85%) of a panel of locally derived CRS clinical isolates. Application of NOV012 to the frontal sinuses of sheep for 20 days was found to be safe, with no observed inflammatory infiltration or tissue damage within the sinus mucosa. Conclusion: NOV012 cocktail appears safe to apply for extended periods to sheep sinuses and it could infect and lyse a wide range of S. aureus CRS clinical isolates. This indicates that phage therapy has strong potential as a treatment for chronic bacterial rhinosinusitis. PMID:28286740

  17. Extramedullary Plasmacytoma of the Frontal Sinus: Case Report and Turkish Literature Review

    PubMed Central

    Verim, Ayşegül; Sheidaii, Shahrouz; Bilaç, Ömer; Karaca, Çiğdem Tepe; Naiboğlu, Barış

    2014-01-01

    Solitary extramedullary plasmacytomas (EMPs) are nonepithelial neoplasms of plasma cell origin categorized among non-Hodgkin lymphomas, without the bone marrow involvement and systemic spread seen in multiple myeloma. They are uncommon tumors comprising 3% of all plasma cell neoplasias. Although they usually occur in the upper respiratory tract, only 1 case of EMP localized to the frontal sinus has been reported in the English literature. We present in this report a rare case of EMP originated from the left frontal sinus leading to left eyeball proptosis and movement restriction. A survey of sinonasal EMPs in the Turkish literature is reported, as well. Paranasal computerized tomography and magnetic resonance imaging of a 69-year-old female who presented with left eyeball proptosis and left-sided headache revealed a solid mass in the left frontal sinus. Histopathological analysis of the completely excised mass supported the diagnosis of plasmacytoma. The definitive diagnosis of solitary EMP was confirmed with further investigations at hematology and oncology clinics. The patient was treated with surgery followed by local radiotherapy to the head and neck region, and she was disease-free at her 1-year follow-up. Treatment of sinonasal EMP is surgery alone or surgery combined with radiotherapy. Long-term follow-up is a requisite for systemic control because of the disease’s high potential to transform into multiple myeloma. PMID:25330525

  18. Extramedullary plasmacytoma of the frontal sinus: case report and Turkish literature review.

    PubMed

    Verim, Ayşegül; Sheidaii, Shahrouz; Bilaç, Omer; Tepe Karaca, Ciğdem; Naiboğlu, Barış

    2014-09-05

    Solitary extramedullary plasmacytomas (EMPs) are nonepithelial neoplasms of plasma cell origin categorized among non-Hodgkin lymphomas, without the bone marrow involvement and systemic spread seen in multiple myeloma. They are uncommon tumors comprising 3% of all plasma cell neoplasias. Although they usually occur in the upper respiratory tract, only 1 case of EMP localized to the frontal sinus has been reported in the English literature. We present in this report a rare case of EMP originated from the left frontal sinus leading to left eyeball proptosis and movement restriction. A survey of sinonasal EMPs in the Turkish literature is reported, as well. Paranasal computerized tomography and magnetic resonance imaging of a 69-year-old female who presented with left eyeball proptosis and left-sided headache revealed a solid mass in the left frontal sinus. Histopathological analysis of the completely excised mass supported the diagnosis of plasmacytoma. The definitive diagnosis of solitary EMP was confirmed with further investigations at hematology and oncology clinics. The patient was treated with surgery followed by local radiotherapy to the head and neck region, and she was disease-free at her 1-year follow-up. Treatment of sinonasal EMP is surgery alone or surgery combined with radiotherapy. Long-term follow-up is a requisite for systemic control because of the disease's high potential to transform into multiple myeloma.

  19. Taste Receptors in Upper Airway Immunity.

    PubMed

    Carey, Ryan M; Lee, Robert J; Cohen, Noam A

    2016-01-01

    Taste receptors are well known for their role in communicating information from the tongue to the brain about nutritional value or potential toxicity of ingested substances. More recently, it has been shown that taste receptors are expressed in other locations throughout the body, including the airway, gastrointestinal tract, brain and pancreas. The roles of some 'extraoral' taste receptors are largely unknown, but emerging research suggests that bitter and sweet taste receptors in the airway are capable of sensing bacteria and modulating innate immunity. This chapter focuses on the role of bitter and sweet taste receptors in human airway innate immunity and their clinical relevance to rhinosinusitis. The bitter taste receptor T2R38 expressed in sinonasal cilia detects bitter bacterial quorum-sensing molecules and activates a nitric oxide-dependent innate immune response; moreover, there are polymorphisms in T2R38 that underlie susceptibility to chronic rhinosinusitis (CRS). Bitter and sweet receptors in sinonasal solitary chemosensory cells control secretion of antimicrobial peptides in the upper airway and may have a profound impact on airway infections in patients with CRS and diabetes. Future research on taste receptors in the airway has enormous potential to expand our understanding of host-pathogen immune interactions and provide novel therapeutic targets.

  20. Immunohistochemistry in diagnosis of extranasopharyngeal angiofibroma originating from nasal cavity: case presentation and review of the literature.

    PubMed

    Perić, Aleksandar; Sotirović, Jelena; Cerović, Snezana; Zivić, Ljubica

    2013-01-01

    Angiofibromas are rare vascular tumors which originate predominantly in the nasopharynx and occur typically in male adolescents. Extranasopharyngeal sites such as nasal cavity and paranasal sinuses are less frequent. This review article was undertaken to evaluate the incidence, clinical features and management of extranasopharyngeal angiofibromas originating exclusivelly from nasal cavity structures. Our focus of interest was to evaluate the significance of immunohistochemical analysis in diagnosis of such extremely rare neoplasms. In the PubMed and Google Search, we found only 39 cases of nasal angifibroma, 27 males and 12 females from 1980 to 2012. The most prevalent site of origin was nasal septum, followed by inferior and middle turbinate. The commonest symptoms were nasal obstruction and epistaxis. Nasal angiofibromas are clinically distinct from nasopharyneal angiofibromas and can therefore be misdiagnosed. The differential diagnosis includes other vascular lesions, such as lobular capillary hemangioma and sinonasal-type hemangiopericytoma. Although immunohistochemistry is not necessary for differentiation between angiofibroma and capillary hemangioma, that diagnostic procedure may be helpful in distinction from sinonasal hemangiopericytoma. As an ilustration for immunohistochemical analysis, we presented a case of an elderly woman with tumor arising from the middle turbinate, diagnosed as angiofibroma. The staining was positive for CD34, CD31, factor VIII, vimentin and smooth muscle alpha-actin, and negative for desmin.

  1. Use of image guidance in endoscopic endonasal surgeries: a 5-year experience.

    PubMed

    Farhadi, M; Jalessi, M; Sharifi, G; Khamesi, S; Bahrami, E; Hammami, M R; Behzadi, A H

    2011-01-01

    Endoscopic endonasal surgery (EES) is standard practice in sinonasal disease and is becoming more accepted in the performance of anterior skull base resections. We report our experience with image-guided surgery (IGS) in difficult cases of paranasal sinus (PNS) and skull base pathologies and discuss advantages and disadvantages of this technique. A retrospective chart review was performed for the period 2004-2009. Degree of PNS involvement, indication for IGS, incidence of major complications, need for revision surgery, and technical data regarding the system were gathered. Sixty-two of 86 patients were followed for at least one year and therefore included in the analysis. Indications for IGS were mostly revision surgery for polyposis (42%), chronic rhinosinusitis (CRS) of frontal and/or sphenoid sinuses (14.5%), skull base tumours (30.6%), and foreign body removal (4.8%). Revision rates after IGS in polyposis, CRS, and benign skull base tumours were 7.7%, 11.11%, and 7.1%, respectively. IGS is of particular benefit in the management of sinonasal polyposis, benign skull base tumours, palliative surgery, and foreign body removal. IGS may avoid trauma to the orbit and anterior skull base and reduces the rate of revision surgeries rendering more meticulous and complete operations possible. We also think it could be helpful for foreign body removal.

  2. Molecular modulation of airway epithelial ciliary response to sneezing.

    PubMed

    Zhao, Ke-Qing; Cowan, Andrew T; Lee, Robert J; Goldstein, Natalia; Droguett, Karla; Chen, Bei; Zheng, Chunquan; Villalon, Manuel; Palmer, James N; Kreindler, James L; Cohen, Noam A

    2012-08-01

    Our purpose was to evaluate the effect of the mechanical force of a sneeze on sinonasal cilia function and determine the molecular mechanism responsible for eliciting the ciliary response to a sneeze. A novel model was developed to deliver a stimulation simulating a sneeze (55 mmHg for 50 ms) at 26°C to the apical surface of mouse and human nasal epithelial cells. Ciliary beating was visualized, and changes in ciliary beat frequency (CBF) were determined. To interrogate the molecular cascades driving sneeze-induced changes of CBF, pharmacologic manipulation of intra- and extracellular calcium, purinergic, PKA, and nitric oxide (NO) signaling were performed. CBF rapidly increases by ≥150% in response to a sneeze, which is dependent on the release of adenosine triphosphate (ATP), calcium influx, and PKA activation. Furthermore, apical release of ATP is independent of calcium influx, but calcium influx and subsequent increase in CBF are dependent on the ATP release. Lastly, we observed a blunted ciliary response in surgical specimens derived from patients with chronic rhinosinusitis compared to control patients. Apical ATP release with subsequent calcium mobilization and PKA activation are involved in sinonasal ciliary response to sneezing, which is blunted in patients with upper-airway disease.

  3. Smell disorders: a study of 132 patients from the first Smell and Taste Clinic of Thailand.

    PubMed

    Kaolawanich, Apichai; Assanasen, Paraya; Tunsuriyawong, Prayuth; Bunnag, Chaweewan; Tantilipikorn, Pongsakorn

    2009-08-01

    To investigate types and possible causes of smell disorders in patients who attended the Smell and Taste Clinic, Siriraj Hospital. Medical records of patients with smell disorders who attended the Smell and Taste Clinic, Siriraj Hospital between July 2002 and August 2005 were reviewed for gender age, duration of complaint, severity (hyposmia or anosmia), and previous medical illnesses (e.g., upper respiratory tract infection (URI), head injury, sinonasal problems, etc). All patients had complete physical examination, nasal endoscopy, and phenyl ethyl alcohol (PEA) olfactory threshold test. One hundred and eighty eight patients' medical records were reviewed. Smell disorders were confirmed in 132 cases (male=58, female=74). Nearly an equal number of anosmia and hyposmia cases were found (50.8% and 49.2% respectively). Possible causes of smell disorders were categorized as follows: sinonasal disease (SND) (66.7%), head injury (12.1%), idiopathic cause (10.6%), URI (6.8%), congenital cause (3%), and others (0.8%). SND was the most common cause of smell disorders despite different age groups and duration of smell disorders. PEA test scores were higher in head injury and idiopathic groups compared with those in SND and post URI groups. The present data showed that SND was the major cause of smell disorders in every age group and in each duration group followed by head injury, idiopathic cause, and URI respectively. Therefore, nasal endoscopy is highly recommended for every patient with smell disorders.

  4. Nasalance Changes Following Various Endonasal Surgeries

    PubMed Central

    Amer, Hazem Saeed; Elaassar, Ahmed Shaker; Anany, Ahmad Mohammad; Quriba, Amal Saeed

    2017-01-01

    Introduction There is change in nasalance post endonasal surgery which is not permanent. Objectives The objective of this study is to evaluate the long-term nasalance changes following different types of endonasal surgeries. Methods We included in this study patients who underwent sinonasal surgery at the Otorhinolaryngology Department in Zagazig University Hospitals from February 2015 until March 2016. We divided the patients into two groups according to the surgeries they underwent: Group (A) was the FESS group and group (B), the septoturbinoplasty group. We checked nasalance using a nasometer before and after the sinonasal surgery. Results Nasalance increased at one month after the operation in both groups. However, it returned to nearly original levels within three months postoperatively. Conclusion FESS, septoplasty, and turbinate surgery may lead to hypernasal speech. This hypernasal speech can be a result of change in the shape and diameter of the resonating vocal tract. Hypernasal speech in these circumstances may be a temporary finding that can decrease with time. Surgeons should inform their patients about the possibility of hypernasality after such types of surgery, especially if they are professional voice users. PMID:28382115

  5. Bitter and sweet taste receptors in the respiratory epithelium in health and disease

    PubMed Central

    Lee, Robert J.; Cohen, Noam A.

    2016-01-01

    Taste receptors on the tongue communicate information to the brain about the nutrient content or potential toxicity of ingested foods. However, recent research has now shown that taste receptors are also expressed far beyond the tongue, from the airway and gastrointestinal epithelia to the pancreas and brain. The functions of many of these so-called extraoral taste receptors remain unknown, but emerging basic science and clinical evidence suggests that bitter and sweet taste receptors in the airway are important in sensing bacteria and regulating innate immunity. This review focuses on the role of bitter and sweet taste receptors in human airway innate immunity and the potential clinical relevance to airway infections. The T2R38 bitter taste receptor in sinonasal cilia detects bitter bacterial quorum-sensing molecules and activates nitric oxide-dependent innate immune responses. Polymorphisms that underlie T2R38 functionality also appear to be involved in susceptibility to upper respiratory infection and chronic rhinosinusitis (CRS). Bitter and sweet receptors in specialized sinonasal solitary chemosensory cells control antimicrobial peptide secretion, which may have important implications for airway infections in CRS patients as well as patients with diabetes mellitus. Future research on taste receptors in the airway has tremendous potential to identify immune mechanisms involved in host-pathogen interactions and thus reveal novel therapeutic targets. PMID:25391251

  6. A rare Japanese case with a NUT midline carcinoma in the nasal cavity: a case report with immunohistochemical and genetic analyses.

    PubMed

    Suzuki, Shioto; Kurabe, Nobuya; Minato, Hiroshi; Ohkubo, Aki; Ohnishi, Ippei; Tanioka, Fumihiko; Sugimura, Haruhiko

    2014-06-01

    NUT (nuclear protein in testis) midline carcinoma (NMC) is a recently described aggressive malignancy that is genetically defined by rearrangements of the NUT locus at 15q14. In approximately two-thirds of cases, the characteristic t(15;19) results in the fusion oncogene BRD4-NUT. Only 10 sinonasal NMCs have been documented, none of which were Japanese cases. An 18-year-old woman was admitted because of a rapidly progressing tumor in the nasal cavity. A biopsy revealed an undifferentiated neoplasm without squamous differentiation. The tumor cells had round to oval nuclei with vesicular chromatin, prominent nucleoli, and scant cytoplasm. Immunohistochemical staining demonstrated a strong positivity for vimentin and NUT, with focal CD138 and only spotty EMA and cytokeratin AE1/AE3 staining. Cytogenetic and fluorescence in situ hybridization analyses revealed a t(15;19) and BRD4-NUT gene rearrangement. Direct sequencing identified the in-frame fusion of exon11 of BRD4 with exon2 of NUT. The patient was transferred to another hospital for chemoradiotherapy. We herein describe the first Japanese case with an NMC of the sinonasal cavity, providing detailed and unambiguous cyto- and molecular genetic information on BRD4-NUT-rearrangement. The accumulation of cases with well-documented genetic data should provide clues to the treatment of this tumor entity. Copyright © 2014 Elsevier GmbH. All rights reserved.

  7. Nasal Cavity and Paranasal Sinus Diseases Affecting Orbit.

    PubMed

    Samil, Kahraman Serif; Yasar, Cokkeser; Ercan, Akbay; Hanifi, Bayarogullari; Hilal, Kahraman

    2015-06-01

    The aim of the authors was to discuss orbital complications of nasal cavity and paranasal sinus diseases. Patients with nasal and paranasal sinus diseases that affected orbit were retrospectively reviewed. Patients with primary orbital abnormality and those without radiologic orbital signs were excluded. Data regarding age and gender distribution, orbital and ocular findings, radiologic findings, and presence of an additional sinonasal disease were analyzed. Disorders affecting orbit were categorized into 6 categories. Mean age was 41.25 ± 22.14 (range: 6-88) years and male:female ratio was 23:18. Overall, there were 41 patients including 11 patients with mucocele, 9 patients with sinusitis, 7 patients with fibrous dysplasia, 4 patients with nasal polyp, 4 patients with paranasal osteoma, and 6 patients with neoplasm. Major clinical presentation was proptosis in these patients. Otolaryngologists should consider the possibility of sinonasal diseases to affect orbit because of vicinity of nasal cavity and paranasal sinuses to orbit. Radiologic imaging is essential to determine the extent, extension, relation with surrounding structures, and initial diagnosis of the disease, and to plan multidisciplinary management.

  8. Mucosal malignant melanoma - a clinical, oncological, pathological and genetic survey.

    PubMed

    Mikkelsen, Lauge H; Larsen, Ann-Cathrine; von Buchwald, Christian; Drzewiecki, Krzysztof T; Prause, Jan U; Heegaard, Steffen

    2016-06-01

    Mucosal melanomas constitute 1.3% of all melanomas and they may develop in any mucosal membrane. Conjunctival melanomas (0.5/million/year) and melanomas in the sinonasal cavity (0.5/million/year) are the most common, followed by anorectal melanomas (0.4/million/year) and melanomas in the oral cavity (0.2/million/year). Anorectal melanoma occurs slightly more often in females, whereas oral melanoma has a male predilection. Mucosal melanoma most commonly develops in a patient's sixth or seventh decade of life, and no differences between races have been found except for sinonasal melanoma and conjunctival melanoma, which are very rare in Black people. The symptoms are not tumour-specific and are related to the organ system affected, and the disease is most often diagnosed at an advanced clinical stage. The diagnosis of a primary tumour is difficult, and metastatic cutaneous melanoma and choroidal melanoma must be excluded. Mutations in KIT are frequently found, while BRAF and NRAS mutations are rarely found - except in conjunctival melanomas that carry BRAF mutations. Mutations in the TERT promotor region are also found in mucosal melanomas. Complete surgical resection with free margins is the treatment of choice. The prognosis is poor, with the 5-year survival rate ranging from 0% (gastric melanoma) to 80% (conjunctival melanoma).

  9. Free-tissue transfer reconstruction of midfacial and cranio-orbito-facial defects.

    PubMed

    Funk, G F; Laurenzo, J F; Valentino, J; McCulloch, T M; Frodel, J L; Hoffman, H T

    1995-03-01

    To review our results using free-tissue transfer to reconstruct midfacial and cranio-orbito-facial defects. Case series. The University of Iowa Hospitals and Clinics, Iowa City. Fourteen of 21 patients had defects that resulted from ablative oncologic surgery; six had severe mid-facial trauma; and one had Romberg's disease. Four latissimus dorsi, 11 rectus abdominis, three scapula, and four forearm free-tissue transfer flaps were used. Adequate flap separation of vital structures (intracranial contents and carotid artery) from the sinonasal or oropharyngeal cavities; restoration of palatal competence, oral diet, and speech intelligibility; maxillary dental rehabilitation; aesthetic results; complications; and the patient's return to social activities outside the home after surgery. The intracranial contents (six cases) or carotid artery (four cases) were protected from sinonasal or oropharyngeal contamination by the reconstructive flap in all cases in which this was required. Functional closure of the palate with the flap or a prosthesis was possible in 12 of the 13 patients with a palatal defect; seven of these 13 patients have had full maxillary dental rehabilitation. Twenty patients take an oral diet. Sixteen patients have normal or easily understood speech. Fourteen patients engage in social activities outside the home, and eight have returned to full-time employment. No vascular flap failures occurred in this series. The use of free-tissue transfer flaps is a safe and effective technique for repairing large midfacial and cranio-orbito-facial defects resulting from ablative oncologic surgery or trauma.

  10. LL-37 causes cell death of human nasal epithelial cells, which is inhibited with a synthetic glycosaminoglycan.

    PubMed

    Thomas, Andrew J; Pulsipher, Abigail; Davis, Brock M; Alt, Jeremiah A

    2017-01-01

    LL-37 is an immune peptide that regulates innate and adaptive immune responses in the upper airways. Elevated levels of LL-37 have been linked to cell death and inflammatory diseases, such as chronic rhinosinusitis (CRS). Glycosaminoglycans (GAGs) are polysaccharides that are found on respiratory epithelial cells and serve important roles in mucosal surface repair. Recent findings suggest that a synthetic glycosaminoglycan (GM-0111) can protect against LL-37-induced sinonasal mucosal inflammation and cell death in a murine model of acute RS. Herein, we elucidated the mechanisms by which LL-37 causes sinonasal inflammation and how GM-0111 can prevent these mechanisms. When challenged with LL-37, human nasal epithelial cells (HNEpCs) and mouse macrophages (J774.2) demonstrated increased release of adenosine triphosphate (ATP) and interleukin (IL)-6 and -8, as well as cell death and lysis. These cellular responses were all blocked dose-dependently by pre-treatment with GM-0111. We identified that LL-37-induced cell death is associated with caspase-1 and -8 activation, but not activation of caspase-3/7. These responses were again blocked by GM-0111. Our data suggest that LL-37 causes cellular death of HNEpCs and macrophages through the pro-inflammatory necrotic and/or pyroptotic pathways rather than apoptosis, and that a GM-0111 is capable of inhibiting these pro-inflammatory cellular events.

  11. Comparison by objective parameters in patients with chronic rhinosinusitis managed medically and surgically (with and without powered instruments)

    PubMed Central

    Behera, Samarendra; Patro, Sourabha K.; Gupta, Ashok K.

    2016-01-01

    Objective: To compare mucociliary clearance time and quality of life in patients who underwent sinus surgery using conventional and powered instruments, and in patients who were treated nonsurgically. Methods: A total of 151 patients with chronic rhinosinusitis were included. Fifty-four patients were treated conservatively, 48 patients were managed surgically by using conventional instruments and 49 patients were managed by using a microdebrider. Kupferberg nasal endoscopy grades, 20-item Sino-Nasal Outcome Test scores, Lund-Mackay scores, and mucociliary clearance time were analyzed. Results: On comparison among the groups, it was found that there was a significant difference between group A (nonsurgically treated) compared with group B (surgery by conventional means) or group C (surgery with microdebrider) in nasal endoscopic grades, Lund-Mackay scores, 20-item Sino-Nasal Outcome Test scores, and mucociliary clearance time. However, in comparison between groups B and C, there was no statistically significant difference. Conclusion: Mucociliary clearance time tended to recover after starting treatment for chronic rhinosinusitis both after conservative treatment and after surgical treatment. Surgery provided better improvement in different objective scores in chronic rhinosinusitis. There exists no statistical difference in parameters independent of the instrument used for surgery. PMID:28107141

  12. Study of inferior turbinate reconstruction with Medpor for the treatment of empty nose syndrome.

    PubMed

    Jiang, Chenyan; Shi, Runjie; Sun, Yiyuan

    2013-05-01

    Patients with empty nose syndrome experience considerable discomfort in their daily lives and treatment is difficult for their physicians. The purpose of this study was to evaluate the outcome of an empty nose syndrome treatment via reconstruction of the inferior turbinate with porous polyethylene (Medpor). A prospective self-controlled study was conducted, and 19 patients suffering from empty nose syndrome underwent a surgical therapy through submucosal implantation of Medpor in order to reconstruct their inferior turbinate. The outcome was assessed by comparison of the preoperative and follow-up symptoms, nasal endoscopy findings, CT scans, mucociliary clearance, acoustic rhinometry, and the Sino-Nasal Outcome Test-20 scores. In a follow-up period of 3 to 18 months, all patients reported subjective symptom improvements and a statistically significant improvement of the Sino-Nasal Outcome Test scores was achieved (P < 0.05). Mucociliary clearance assessments showed improvements at 3, 6, and 12 months postoperatively, but without statistical significance. Acoustic rhinometry assessments showed postoperative improvements of nasal resistance, nasal volume, and minimum cross-sectional area with a significant overall average score (P < 0.05). The reconstruction of inferior turbinate with Medpor is a new promising approach to treat patients with empty nose syndrome. 4. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  13. Chronic Rhinosinusitis with Nasal Polyps

    PubMed Central

    Stevens, Whitney W.; Schleimer, Robert P.; Kern, Robert C.

    2016-01-01

    Chronic rhinosinusitis with nasal polyps (CRSwNP) is an important clinical entity diagnosed by the presence of both subjective and objective evidence of chronic sinonasal inflammation. Symptoms include anterior or posterior rhinorrhea, nasal congestion, hyposmia and/or facial pressure or pain that last for greater than 12 weeks duration. Nasal polyps are inflammatory lesions that project into the nasal airway, are typically bilateral, and originate from the ethmoid sinus. Males are more likely to be affected than females but no specific genetic or environmental factors have been strongly linked to the development of this disorder to date. CRSwNP is frequently associated with asthma and allergic rhinitis but the cellular and molecular mechanisms that contribute to the clinical symptoms are not fully understood. Defects in the sinonasal epithelial cell barrier, increased exposure to pathogenic and colonized bacteria, and dysregulation of the host immune system are all thought to play prominent roles in disease pathogenesis. Additional studies are needed to further explore the clinical and pathophysiological features of CRSwNP so that biomarkers can be identified and novel advances can be made to improve the treatment and management of this disease. PMID:27393770

  14. Nasal endoscopy and paranasal sinus computerised tomography (CT) findings in an Irish cystic fibrosis adult patient group.

    PubMed

    Casserly, P; Harrison, M; O'Connell, O; O'Donovan, N; Plant, B J; O'Sullivan, P

    2015-11-01

    Cystic fibrosis (CF) is a common inherited disorder in Caucasians in Ireland having the highest reported incidence. CF has well-recognised clinical sequelae in several physiological systems. Its' impact on the sinonasal system is less well established. We evaluated symptoms, endoscopic and computerised tomographic (CT) findings in an Irish adult CF group with the aim of characterising the relationship between these clinical features in an Irish CF group. Adult CF patients attending a specialist clinic underwent prospective evaluation of sinonasal symptoms using a specifically designed questionnaire. They subsequently underwent nasoendoscopy and CT scanning of their paranasal sinuses. Abnormalities identified were quantified using established radiological (Lund-Mackay) and endoscopic (Lund-Kennedy) scoring systems. The relationship between symptoms of chronic rhinosinusitis (CRS), endoscopic findings and CT abnormalities were then compared. Sixty-three CF patients (n = 63) were studied. 29 patients had a CT scan. Thirty-three CF patients (52%) had no symptoms of CRS. Fifty CF patients (80% of CF group) had evidence of CRS on nasoendoscopy including thirteen patients (20%) with nasal polyposis. 98% of patients scanned have positive findings on CT scan. There was no significant difference between symptomatic and asymptomatic CF groups with respect to their Lund-Kennedy endoscopic score or their Lund-Mackay CT score. 86% demonstrated one or more hypoplastic sinus. There was no increased incidence of hypoplastic sinuses amongst Δf508 homozygotes than other mutation groups.

  15. Trephination of the frontal sinuses and instillation of clotrimazole cream: a computed tomographic study in canine cadavers.

    PubMed

    Burrow, Rachel; Baker, Martin; White, Lindsay; McConnell, James Fraser

    2013-04-01

    To use computed tomography (CT) to assess the distribution of surgically administered clotrimazole cream and associated filling of the frontal sinuses and caudal aspect of the nasal cavities in canine cadavers. Observational study. Small (n = 1) and medium-large (n = 11) breed canine cadavers. CT scans of 12 cadaveric canine heads were used to confirm absence of sinonasal disease. Then after creating an opening into the left and right frontal sinuses with a 3.2 mm Steinmann pin at standardized landmarks, clotrimazole cream (20 g) was instilled into each side. Postoperative CT scans of the heads was used to assess the distribution and degree of filling of the sinonasal cavities with clotrimazole cream, and to identify any damage to local structures. Filling was excellent in 22 sinuses, very poor in 2, and excellent in all caudal nasal cavities. Two cadavers had damage: unilateral penetration of the cranium (2) and unilateral penetration of the lateral sinus wall (1). Excellent filling of most of the frontal sinuses and caudal nasal cavity of cadavers with clotrimazole cream is achieved when administered by this technique. Damage to local structures may occur intraoperatively using this technique. © Copyright 2013 by The American College of Veterinary Surgeons.

  16. A Computational Study of Nasal Spray Deposition Pattern in Four Ethnic Groups

    PubMed Central

    Keeler, Jarrod A.; Patki, Aniruddha; Woodard, Charles R.

    2016-01-01

    Abstract Background: Very little is known about the role of nasal morphology due to ethnic variation on particle deposition pattern in the sinonasal cavity. This preliminary study utilizes computational fluid dynamics (CFD) modeling to investigate sinonasal airway morphology and deposition patterns of intranasal sprayed particles in the nose and sinuses of individuals from four different ethnic groups: African American (Black); Asian; Caucasian; and Latin American. Methods: Sixteen subjects (four from each ethnic group) with “normal” sinus protocol computed tomography (CT) were selected for CFD analysis. Three-dimensional reconstruction of each subject's sinonasal cavity was created from their personal CT images. CFD simulations were carried out in ANSYS Fluent™ in two phases: airflow phase was done by numerically solving the Navier-Stokes equations for steady state laminar inhalation; and particle dispersed phase was solved by tracking injected (sprayed) particles through the calculated airflow field. A total of 10,000 particle streams were released from each nostril, 1000 particles per diameter ranging from 5 μm to 50 μm, with size increments of 5 μm. Results: As reported in the literature, Caucasians (5.31 ± 0.42 cm−1) and Latin Americans (5.16 ± 0.40cm−1) had the highest surface area to volume ratio, while African Americans had highest nasal index (95.91 ± 2.22). Nasal resistance (NR) was highest among Caucasians (0.046 ± 0.008 Pa.s/mL) and Asians (0.042 ± 0.016Pa.s/mL). Asians and African Americans had the most regions with particle deposition for small (5 μm–15 μm) and large (20 μm–50 μm) particle sizes, respectively. Asians and Latin Americans individuals had the most consistent regional particle deposition pattern in the main nasal cavities within their respective ethnic groups. Conclusions: Preliminary results from these ethnic groups investigated showed that Caucasians and Latin Americans had

  17. A Computational Study of Nasal Spray Deposition Pattern in Four Ethnic Groups.

    PubMed

    Keeler, Jarrod A; Patki, Aniruddha; Woodard, Charles R; Frank-Ito, Dennis O

    2016-04-01

    Very little is known about the role of nasal morphology due to ethnic variation on particle deposition pattern in the sinonasal cavity. This preliminary study utilizes computational fluid dynamics (CFD) modeling to investigate sinonasal airway morphology and deposition patterns of intranasal sprayed particles in the nose and sinuses of individuals from four different ethnic groups: African American (Black); Asian; Caucasian; and Latin American. Sixteen subjects (four from each ethnic group) with "normal" sinus protocol computed tomography (CT) were selected for CFD analysis. Three-dimensional reconstruction of each subject's sinonasal cavity was created from their personal CT images. CFD simulations were carried out in ANSYS Fluent(™) in two phases: airflow phase was done by numerically solving the Navier-Stokes equations for steady state laminar inhalation; and particle dispersed phase was solved by tracking injected (sprayed) particles through the calculated airflow field. A total of 10,000 particle streams were released from each nostril, 1000 particles per diameter ranging from 5 μm to 50 μm, with size increments of 5 μm. As reported in the literature, Caucasians (5.31 ± 0.42 cm(-1)) and Latin Americans (5.16 ± 0.40cm(-1)) had the highest surface area to volume ratio, while African Americans had highest nasal index (95.91 ± 2.22). Nasal resistance (NR) was highest among Caucasians (0.046 ± 0.008 Pa.s/mL) and Asians (0.042 ± 0.016Pa.s/mL). Asians and African Americans had the most regions with particle deposition for small (5 μm-15 μm) and large (20 μm-50 μm) particle sizes, respectively. Asians and Latin Americans individuals had the most consistent regional particle deposition pattern in the main nasal cavities within their respective ethnic groups. Preliminary results from these ethnic groups investigated showed that Caucasians and Latin Americans had the least patent nasal cavity. Furthermore, Caucasians

  18. Culture-directed topical antibiotic treatment for chronic rhinosinusitis

    PubMed Central

    Davis, Greg E.

    2016-01-01

    Background: Topical antibiotics, delivered optimally as high-volume culture-directed sinus irrigations, are being increasingly used for recalcitrant chronic rhinosinusitis (CRS). Their impact on subjective and objective outcome measures, however, is still unclear. Objective: To assess if the use of topical antibiotics in recalcitrant CRS is associated with improved 20-Item Sino-Nasal Outcome Test and Lund-Kennedy endoscopic scores, and to determine the negative posttreatment culture “control” rate. Methods: Patients were included in the study if they met diagnostic criteria for CRS, received high-volume topical antibiotic sinus irrigations twice daily for 1 month, between December 2009 and May 2015, and had undergone endoscopic sinus surgery. The primary outcome was the 20-Item Sino-Nasal Outcome Test score. Secondary outcomes were the Lund-Kennedy endoscopic score and a negative posttreatment culture “control” rate. Paired t-tests were used to compare pre- and posttreatment scores. Patients with cystic fibrosis were analyzed separately. Results: Of the 58 patients included, 47% had nasal polyposis, 57% had asthma, 16% had aspirin sensitivity, and 55% had environmental allergies. The median Lund-Mackay computed tomography score was 11 (interquartile range, 6–16), and the median time to follow-up was 8 weeks (interquartile range, 6–10 weeks). The 20-Item Sino-Nasal Outcome Test scores improved from pre- to posttreatment period, although this was not significant mean 1.5 [confidence interval {CI} 1.3, 1.7] to mean 1.3 [CI 1.1, 1.6]; p = 0.16). Lund-Kennedy endoscopic scores, however, significantly improved from pre- to posttreatment (mean 4.9 [CI 4.3, 5.6] to mean 4.1 [CI 3.5, 4.7]; p = 0.05). Of the 47 patients with complete culture data, 72% had negative posttreatment culture results, defined as “controlled.” Only one patient discontinued treatment, related to discomfort from irrigations. Conclusion: In patients with recalcitrant CRS, the use of

  19. Cross-cultural adaptation and validation of the Sinus and Nasal Quality of Life Survey (SN-5) into Brazilian Portuguese.

    PubMed

    Uchoa, Priscila Regina Candido Espinola; Bezerra, Thiago Freire Pinto; Lima, Élcio Duarte; Fornazieri, Marco Aurélio; Pinna, Fabio de Rezende; Sperandio, Fabiana de Araújo; Voegels, Richard Louis

    The concept of quality of life is subjective and variable definition, which depends on the individual's perception of their state of health. Quality of life questionnaires are instruments designed to measure quality of life, but most are developed in a language other than Portuguese. Questionnaires can identify the most important symptoms, focus on consultation, and assist in defining the goals of treatment. Some of these have been validated for the Portuguese language, but none in children. To validate the translation with cross-cultural adaptation and validation of the Sinus and Nasal Quality of Life Survey (SN-5) into Portuguese. Prospective study of children aged 2-12 years with sinonasal symptoms of over 30 days. The study comprised two stages: (I) translation and cross-cultural adaptation of the SN-5 into Portuguese (SN-5p); and (II) validation of the SN5-p. Statistical analysis was performed to assess internal consistency, test-retest reliability, and sensitivity, as well as construct and discriminant validity and standardization. The SN-5 was translated and adapted into Portuguese (SN-5p) and the author of the original version approved the process. Validation was carried out by administration of the SN-5p to 51 pediatric patients with sinonasal complaints (mean age, 5.8±2.5 years; range, 2-12 years). The questionnaire exhibited adequate construct validity (0.62, p<0.01), internal consistency (Cronbach's alpha=0.73), and discriminant validity (p<0.01), as well as good test-retest reproducibility (Goodman-Kruskal gamma=0.957, p<0.001), good correlation with a visual analog scale (r=0.62, p<0.01), and sensitivity to change. This study reports the successful translation and cross-cultural adaptation of the SN-5 instrument into Brazilian Portuguese. The translated version exhibited adequate psychometric properties for assessment of disease-specific quality of life in pediatric patients with sinonasal complaints. Copyright © 2016 Associação Brasileira de

  20. The role of viruses in the clinical presentation of chronic rhinosinusitis.

    PubMed

    Rowan, Nicholas R; Lee, Stella; Sahu, Nivedita; Kanaan, Alyssa; Cox, Stephen; Phillips, Caleb D; Wang, Eric W

    2015-01-01

    The role of viruses in chronic rhinosinusitis (CRS) is poorly understood. In part, this is secondary to difficulty in isolating viruses. Although traditional detection methods for respiratory viruses have had little clinical utility, modern viral screening techniques that use molecular sequencing are now both rapid and feasible, which makes analysis of the paranasal sinus microbiome more accessible. To detect respiratory viruses in the paranasal sinuses of patients with CRS and of healthy controls as well as to correlate clinical and radiographic measures of CRS with viral presence. In this prospective study, 13 patients with CRS with nasal polyposis (CRSwNP) and 8 patients without nasal polyposis (CRSsNP) were enrolled and compared with 14 healthy controls. Samples were obtained from the paranasal sinuses and were screened for viral DNA with polymerase chain reaction--based sequencing techniques. Typical symptoms of CRS, the Sinonasal Questionnaire, and objective measures, including the modified Lund-Mackay and modified Lund-Kennedy scores were obtained. Eighty percent of the positive screens (4/5) were found in patients with CRSsNP, whereas 20% of the positive tests (1/5) were in the CRSwNP group, and none of the controls tested positive (p = 0.0029). Coronavirus was the most common virus detected. Sinonasal Questionnaire scores of the patients with CRS who tested positive for viruses were higher but not statistically different than those without a positive screen (p = 0.31). Radiographic and endoscopic measures of disease were not significantly different in the setting of a positive viral screen (p = 0.12 and 0.11 respectively). Although traditionally difficult, advances in molecular sequencing enhance detection of viruses in the sinonasal tract. In this study, respiratory viruses were more commonly isolated from patients with CRS compared with healthy controls. Moreover, viral infection may play a greater role in symptom exacerbation in CRSsNP than in CRSw

  1. [Correlation between psychological state and emotional intelligence in residents of gynecology, and obstetrics].

    PubMed

    Carranza-Lira, Sebastián

    2016-01-01

    Introducción: la inteligencia emocional se refiere a las capacidades individuales para percibir emociones, a la manera como estas se deben entender y a su utilización de manera productiva. Como el estado psicológico alterado puede modificar la inteligencia emocional, el objetivo de este estudio consistió en correlacionar el estado psicológico con la inteligencia emocional en residentes de ginecología y obstetricia. Métodos: la influencia del estado psicológico y la inteligencia emocional se evaluó en 76 residentes de ginecología y obstetricia con los instrumentos What’s my M3 y TMMS-24. Resultados: en los varones de segundo grado hubo una correlación positiva entre el trastorno obsesivo compulsivo (TOC) con la atención emocional (AE) y una correlación negativa con la claridad emocional (CE). En los de tercer grado, la ansiedad, el trastorno bipolar (TBP) y el trastorno por estrés post traumático (TPSPT) se correlacionaron positivamente con la AE. En los de cuarto grado hubo correlación positiva del TOC con la AE. En las mujeres de segundo grado, la depresión se correlacionó negativamente con la reparación emocional (RE). En las mujeres de tercer grado, la ansiedad, el TBP y el TPSPT se correlacionaron positivamente con la AE y en las de cuarto grado hubo una correlación negativa de la depresión con la AE y de la ansiedad, el TOC y el TPSPT con la CE. Conclusión: el estado psicológico tiene un efecto favorable en la atención emocional y desfavorable en la claridad emocional y en la reparación emocional.

  2. Pathogenicity of seed transmittedFusarium spp. to triticale seedlings.

    PubMed

    Arseniuk, E; Scharen, A L; Czembor, H J

    1991-09-01

    In the conducted studies 13 species ofFusarium were isolated into pure culture from triticale seed. Their pathogenicity was assessed under laboratory and greenhouse conditions. Most of the species studied were highly pathogenic to the first leaf see-dlings of triticale 'Grado' and 'Lasko' under both sets of conditions. It was shown, that seed-transmitted Fusarium spp. considerably reduced the ability of seeds to germinate and incited seedling blight. On average, triticale 'Lasko' was more resistant toFusarium spp. than 'Grado', but in some instances a reverse reaction was observed.

  3. Aspergillus and aspergilloses in wild and domestic animals: a global health concern with parallels to human disease.

    PubMed

    Seyedmousavi, Seyedmojtaba; Guillot, Jacques; Arné, Pascal; de Hoog, G Sybren; Mouton, Johan W; Melchers, Willem J G; Verweij, Paul E

    2015-11-01

    The importance of aspergillosis in humans and various animal species has increased over the last decades. Aspergillus species are found worldwide in humans and in almost all domestic animals and birds as well as in many wild species, causing a wide range of diseases from localized infections to fatal disseminated diseases, as well as allergic responses to inhaled conidia. Some prevalent forms of animal aspergillosis are invasive fatal infections in sea fan corals, stonebrood mummification in honey bees, pulmonary and air sac infection in birds, mycotic abortion and mammary gland infections in cattle, guttural pouch mycoses in horses, sinonasal infections in dogs and cats, and invasive pulmonary and cerebral infections in marine mammals and nonhuman primates. This article represents a comprehensive overview of the most common infections reported by Aspergillus species and the corresponding diseases in various types of animals.

  4. [Aerosinusitis. Part 2: Diagnosis, therapy and recommencement of flight duties].

    PubMed

    Weber, R; Kühnel, T; Graf, J; Hosemann, W

    2014-04-01

    Aerosinusitis more frequently affects the frontal sinus than the maxillary sinus and mostly occurs during descent. Sinonasal diseases and anatomic variations leading to obstruction of paranasal sinus ventilation favor the development of aerosinusitis. This Continuing Medical Education (CME) article is based on selective literature searches of the PubMed database (search terms: "aerosinusitis", "barosinusitis", "barotrauma" AND "sinus", "barotrauma" AND "sinusitis", "sinusitis" AND "flying" OR "aviator"). Additionally, currently available monographs and further articles that could be identified based on the publication reviews were also included. In part 2, diagnostic measures, drug therapy, balloon dilatation and endoscopic sinus surgery are presented, along with a discussion regarding when flight attendants and pilots are able to resume their work. Endoscopic surgery to expand the natural drainage pathways of the affected sinuses with minimal surgical trauma to the healthy mucous membranes is largely successful.

  5. [Aerosinusitis: part 1: Fundamentals, pathophysiology and prophylaxis].

    PubMed

    Weber, R; Kühnel, T; Graf, J; Hosemann, W

    2014-01-01

    The relevance of aerosinusitis stems from the high number of flight passengers and the impaired fitness for work of the flight personnel. The frontal sinus is more frequently affected than the maxillary sinus and the condition generally occurs during descent. Sinonasal diseases and anatomic variations leading to obstruction of paranasal sinus ventilation favor the development of aerosinusitis. This Continuing Medical Education (CME) article is based on selective literature searches of the PubMed database (search terms: "aerosinusitis", "barosinusitis", "barotrauma" AND "sinus", "barotrauma" AND "sinusitis", "sinusitis" AND "flying" OR "aviator"). Additionally, currently available monographs and further articles that could be identified based on the publication reviews were also included. Part 1 presents the pathophysiology, symptoms, risk factors, epidemiology and prophylaxis of aerosinusitis. In part 2, diagnosis, conservative and surgical treatment will be discussed.

  6. Chronic orbital inflammatory disease and optic neuropathy associated with long-term intranasal cocaine abuse: 2 cases and literature review.

    PubMed

    Siemerink, Martin J; Freling, Nicole J M; Saeed, Peerooz

    2017-10-01

    Orbital inflammatory disease and secondary optic neuropathy is a rare but devastating complication of long-term intranasal cocaine abuse. We describe 2 patients with a history of intranasal cocaine consumption who presented with subacute onset of unilateral vision loss from optic neuropathy and limitation of abduction in the affected eye. Magnetic resonance imaging findings included an orbital mass in combination with absent nasal septum and partial destruction of the paranasal sinuses. Biopsies and histopathologic examination of the nasal cavity and the orbital mass revealed chronic inflammation. Both patients were treated with oral corticosteroids, ocular movements completely normalized but no improvement of visual acuity was noted. Intranasal cocaine abuse can cause orbital complications from chronic sinonasal inflammatory disease and these patients are at risk to develop optic neuropathy. Optic neuropathy may be caused by compression, infiltration, or ischaemia.

  7. Pathophysiology of chronic rhinosinusitis.

    PubMed

    Tomassen, Peter; Van Zele, Thibaut; Zhang, Nan; Perez-Novo, Claudina; Van Bruaene, Nicholas; Gevaert, Philippe; Bachert, Claus

    2011-03-01

    Chronic rhinosinusitis (CRS), a disease presenting with chronic symptoms such as nasal obstruction, rhinorrhea, hyposmia and facial pain, is highly prevalent and has a considerable impact on quality of life and health care expenditures. The disease is characterized by chronic inflammation of the sinonasal mucosa and can present with nasal polyps. Current consensus classifies CRS into CRS with nasal polyps and CRS without nasal polyps. This review illustrates the diversity of pathophysiological observations in CRS and highlights selected etiological hypotheses. A wide spectrum of alterations is described regarding histopathology, pattern of T cells and inflammatory effector cells, remodeling, immunoglobulin production, chemokine and eicosanoid production, and the role of microorganisms. The pathophysiological diversity observed in CRS seems to stand in contrast to its nonspecific clinical presentation, but is of the utmost importance in the development and application of highly individualized treatments. Identification of specific disease subgroups and their etiologies is an important and challenging task for future research.

  8. Translocation t(12;17)(q24.1;q21) as the sole anomaly in a nasal chondromesenchymal hamartoma arising in a patient with pleuropulmonary blastoma.

    PubMed

    Behery, Radwa El; Bedrnicek, Jiri; Lazenby, Audrey; Nelson, Marilu; Grove, Jennifer; Huang, Dali; Smith, Russell; Bridge, Julia A

    2012-01-01

    The identification of recurrent chromosomal abnormalities in benign and malignant mesenchymal neoplasms has provided important pathogenetic insight as well as powerful diagnostic adjuncts. Nasal chondromesenchymal hamartoma (NCMH), an extremely rare benign tumor arising in the sinonasal tract of infants and children, has not been previously subjected to cytogenetic analysis. Histopathologically composed of mixed mesenchymal elements, NCMH exhibits a relatively wide differential diagnosis to include chondromyxoid fibroma, chondroblastoma, aneurysmal bone cyst, fibrous dysplasia, and osteochondromyxoma. An interesting association with pleuropulmonary blastoma has been reported in a small subset of NCMH patients. In the current study, cytogenetic analysis of a NCMH arising in an 11-year-old boy with a past medical history of pleuropulmonary blastoma revealed a novel 12;17 translocation, t(12;17)(q24.1;q21), as the sole anomaly.

  9. Antibody deficiency in chronic rhinosinusitis: epidemiology and burden of illness.

    PubMed

    Ocampo, Christopher J; Peters, Anju T

    2013-01-01

    A subset of patients with chronic rhinosinusitis (CRS) has refractory disease. The risk factors for refractory CRS include atopy, a disrupted mucociliary transport system, medical conditions affecting the sinonasal tract mucosa, and immunodeficiency. We review four primary immunodeficiencies reported in individuals with CRS: common variable immune deficiency (CVID), selective IgA deficiency, IgG subclass deficiency, and specific antibody deficiency. We also review treatment options for individuals with both CRS and a concomitant immune defect. There is a high prevalence of CRS in individuals with CVID and selective IgA deficiency. While many reports describe IgG subclass deficiency in individuals with CRS, the clinical relevance of this is unclear. Specific antibody deficiency may play a more significant role in the pathogenesis of refractory CRS. Screening for a primary immunodeficiency should be part of the diagnostic workup of refractory CRS, as its identification may allow for more effective long-term therapeutic options.

  10. Nasal infection due to Mycobacterium fortuitum.

    PubMed

    Nguyen, D-Q; Righini, C; Darouassi, Y; Schmerber, S

    2011-09-01

    Mycobacterium fortuitum, a rapidly growing non-tuberculous atypical mycobacterium, is commonly found in soil and water. This organism generally causes skin, bone, and soft tissue infections following local trauma or surgical procedures, and in immunodeficient patients. The case reported here is, to our knowledge, the first published report of M. fortuitum nasal infection. The authors report the case of a 3-year-old girl with intranasal tumour-like swelling associated with cervical lymph nodes due to M. fortuitum infection. A combination of radical surgical debridement and prolonged therapy with several antimicrobial agents was required to completely eradicate the infection. This case report indicates that non-tuberculous mycobacterial infections should be considered after failure of conventional antibiotic therapy or when classical microbiological tests fail to identify the pathogen responsible for sinonasal and cervical infections. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  11. Intraoral transposition of pedicled temporalis muscle flap followed by zygomatic implant placement.

    PubMed

    Pia, Francesco; Aluffi, Paolo; Crespi, Maria Cristina; Arcuri, Francesco; Brucoli, Matteo; Benech, Arnaldo

    2012-09-01

    Despite the recent advances of sophisticated reconstructive surgical techniques, management of maxillectomy defects continues to be challenging. For a selected group of patients, who cannot sustain a sophisticated microsurgical reconstructive procedure, a prosthetic obturator is indicated to separate the oral cavity from the sinonasal cavities. After the development of the osseointegration concept, dental implants have proven to be indicated for the rehabilitation of patients who underwent maxillectomy. Recently, surgeons can use a computer-assisted software package, which enables them to insert implants after a detailed analysis of the residual bone. For some patients with limited amount of residual maxillary bone, unusual surgical sites such as the zygomatic complex have been tested. We introduce a successful 2-step surgical procedure using a pedicled temporalis muscle flap and zygomatic implant placement to reconstruct a maxillary defect after oncological resection.

  12. Endovascular management of postoperative pseudoaneurysms of the external carotid artery.

    PubMed

    Cohen, José E; Gomori, John M; Moscovici, Samuel; Grigoriadis, Savvas; Ramirez de Noriega, Fernando; Itshayek, Eyal

    2012-05-01

    Hemorrhage secondary to postoperative pseudoaneurysm is a rare event, but may complicate the clinical course of straightforward and common interventions such as sinonasal procedures, tonsillectomy, and maxillofacial and plastic surgeries. We report our experience with the endovascular management of iatrogenic pseudoaneurysm in eight patients who had undergone recent craniomaxillofacial surgery. Computed tomography (CT), including CT-angiography, detected only three of the eight lesions. In all patients, endovascular embolization achieved successful occlusion of the pseudoaneurysm without local or general procedure-related complications. Immediate proximal arterial occlusion with detachable coils was performed in every case, and pseudoaneurysm coiling was performed in three cases presenting with active hemorrhage. Endovascular therapy proved to be safe and effective in the management of postoperative pseudoaneurysms. Surgeons involved in the craniomaxillofacial procedures should be aware of this complication and its management. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. [Solitary fibrous tumor of the nose and paranasal sinuses].

    PubMed

    Kyriafinis, G; Constantinidis, J; Karkavelas, G; Triaridis, S; Daniilidis, J

    2006-12-01

    The solitary fibrous tumor is an uncommon, benign lesion with a mesenchymal origin which arises most commonly from the pleura and, in extremely rare cases, from the mucosa of the nose and paranasal sinuses. We describe a case of solitary fibrous tumor in the nasal cavity with an extension into both ethmoid sinuses and destruction of the nasal septum in a 64-year-old woman presenting with nasal obstruction and frontal headache. In the histopathologic examination and by immunohistochemistry, the tumor was composed of spindle cells and nodular collagen, and was confirmed as a solitary fibrous tumor. It was completely removed using an endonasal approach with the patient being free of any complaints and without evidence of disease 2 years after surgery. Solitary fibrous tumor should be included in diagnostic considerations in patients with sinonasal masses, especially in cases with the appearance of spindle cells. Diagnostic procedures, clinicopathological features, therapeutic options and prognosis of the such tumors are discussed.

  14. Variations in radiation dose between the same model of multislice CT scanner at different hospitals.

    PubMed

    Koller, C J; Eatough, J P; Bettridge, A

    2003-11-01

    The variation in exposure factors and patient dose, between seven centres using identical multislice CT scanners, was investigated for six standard examinations. Dose values were compared with each other and the relevant diagnostic reference level (DRL) for each examination. The range in weighted CT dose index (CTDI(w)) values between the seven centres was small for abdominal scans and head scans. For other scans however, such as functional endoscopic sinonasal surgery (FESS) the variations in CTDI(w) were as high as a factor of seven between the lowest and the highest values. At one centre a program of dose optimization had been undertaken and this centre had CTDI(w) values ranging from 3% to 64% lower than the average value for the seven centres. This demonstrates that significant dose reduction can be achieved through close collaboration between medical physicists, radiologists and radiographers.

  15. Antibody deficiency in chronic rhinosinusitis: Epidemiology and burden of illness

    PubMed Central

    Ocampo, Christopher J.

    2013-01-01

    Background: A subset of patients with chronic rhinosinusitis (CRS) has refractory disease. The risk factors for refractory CRS include atopy, a disrupted mucociliary transport system, medical conditions affecting the sinonasal tract mucosa, and immunodeficiency. Methods: We review four primary immunodeficiencies reported in individuals with CRS: common variable immune deficiency (CVID), selective IgA deficiency, IgG subclass deficiency, and specific antibody deficiency. We also review treatment options for individuals with both CRS and a concomitant immune defect. Results: There is a high prevalence of CRS in individuals with CVID and selective IgA deficiency. While many reports describe IgG subclass deficiency in individuals with CRS, the clinical relevance of this is unclear. Specific antibody deficiency may play a more significant role in the pathogenesis of refractory CRS. Conclusion: Screening for a primary immunodeficiency should be part of the diagnostic workup of refractory CRS, as its identification may allow for more effective long-term therapeutic options. PMID:23406598

  16. Radioresistant Extramedullary Plasmacytoma of the Maxillary Sinus: A Case Report and review article

    PubMed Central

    Ghazizadeh, Matin; Alavi Amlashi, Hesamodin; Mehrparvar, Golfam

    2015-01-01

    Introduction: Plasmacytoma is a monoclonal proliferation of plasma cells. It can be an isolated lesion, for which the term extramedullary plasmacytoma is used, or a representation of multiple myeloma.The upper respiratory tract is the most common site for an extramedullary plasmacytoma. Sinonasal plasmacytomas cause different symptoms depending on the sites of origins and the areas of involvement. The treatment of choice for extramedullary plasmacytoma is local radiotherapy. Although it is generally accepted that plasmacytomas are radiosensitive, there are reports of cases that do not respond to radiotherapy. Case Report: A case of a 24-year-old male diagnosed with radioresistant extramedullary plasmacytoma of the maxillary sinus, who responded to surgical treatment, is reported. Conclusion: It is reasonable to consider an interdisciplinary approach in the management of extramedullary plasmacytoma. Considering early surgical intervention in cases encompassing risk factors of radiotherapy resistance is especially recommended before debilitating complications emerge. PMID:26788481

  17. Re-establishment of olfactory and taste functions

    PubMed Central

    Welge-Lüssen, Antje

    2005-01-01

    The incidence of olfactory disorders is appoximately 1-2% and they can seriously impact on the quality of life. Quantitative disorders (hyposmia, anosmia) are distinguished from qualitative disorders (parosmia, phantosmia). Olfactory disorders are classified according to the etiology and therapy is planned according to the underlying pathophysiology. In ENT patients olfactory disorders caused by sinonasal diseases are the most common ones, followed by postviral disorders. Therapy consists of topical and systemic steroids, whereas systemic application seems to be of greater value. It is very difficult to predict the improvement of olfactory function using surgery, moreover, the long term - success in surgery is questionable. Isolated taste disorders are rare and in most often caused by underlying diseases or side effects of medications. A meticulous history is necessary and helps to choose effective treatment. In selected cases zinc might be useful. PMID:22073054

  18. Global airway disease beyond allergy.

    PubMed

    Hellings, Peter W; Prokopakis, Emmanuel P

    2010-03-01

    Besides the anatomic continuity of the upper and lower airways, inflammation in one part of the airway influences the homeostasis of the other. The mechanisms underlying this interaction have been studied primarily in allergic disease, showing systemic immune activation, induction of inflammation at a distance, and a negative impact of nasal inflammation on bronchial homeostasis. In addition to allergy, other inflammatory conditions of the upper airways are associated with lower airway disease. Rhinosinusitis is frequently associated with asthma and chronic obstructive pulmonary disease. The impairment of purification, humidification, and warming up of the inspired air by the nose in rhinosinusitis may be responsible in part for bronchial pathology. The resolution of sinonasal inflammation via medical and/or surgical treatment is responsible for the beneficial effect of the treatment on bronchial disease. This article provides a comprehensive overview of the current knowledge of upper and lower airway communication beyond allergic disease.

  19. Endoscopic Sinus Surgery for Treatment of Kartagener Syndrome: A Case Report

    PubMed Central

    Tang, Xinghua; Zou, Jian; Liu, Shixi

    2013-01-01

    Background: Kartagener syndrome (KS) is a rare congenital disease characterised by a clinical triad of symptoms: situs inversus, chronic rhinosinusitis, and bronchiectasis. Although congenital ciliary defect is recognised as the main cause of this syndrome, it remains difficult to treat the associated airway infection. Case Report: A 17-year-old female patient presented with repeated refractory airway infection. She also had bronchiectasis and situs inversus. Electron microscopic evaluation of her nasal mucosa revealed ciliary defect and confirmed the diagnosis of KS. She underwent functional endoscopic sinus surgery (FESS) followed by long-term postoperative debridement of the sinonasal cavity. This treatment reduced chronic rhinosinusitis and protected against subsequent airway infection in a 7-year follow-up. Conclusion: FESS is effective for relieving both chronic rhinosinusitis and lung infection of KS in the long term. PMID:25207108

  20. Sclerosing lipogranuloma of the eyelid: unusual complication following nasal packing in endoscopic sinus surgery

    PubMed Central

    Ramaswamy, Balakrishnan; Singh, Rohit; Manusrut, Manusrut; Hazarika, Manali

    2015-01-01

    An eyelid or orbital lipogranuloma can occur following nasal packing with liquid paraffin, petroleum jelly or an antibiotic-based cream. It usually presents a few weeks or months after the initial procedure. We present a report of three such cases of sclerosing lipogranuloma involving the eyelid, which occurred following a sinonasal surgery where nasal packing using petroleum jelly was performed. The typical clinical course and the classical histopathological features are highlighted. All cases were diagnosed by histopathological examination as sclerosing lipogranuloma. Complete surgical removal resulted in complete resolution on 1 month follow-up. The diagnosis is based on a high degree of suspicion following a detailed history of prior use of lipid-based products for nasal packing following endonasal surgery. Histopathology is diagnostic. Surgical excision is the treatment of choice, however, due to its infiltrative nature, it may be difficult to obtain a complete cure. PMID:25750223

  1. [Accidental discovery of 18F-fluorodeoxyglucose PET/CT-positive papilloma in sinus sphenoidalis in a patient with recurrence of breast cancer].

    PubMed

    Hansen, Lasse Berg

    2015-02-02

    A patient suspected for metastatic breast cancer went through an 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT). Along with metastatic lymph nodes in the neck it showed high 18F-FDG uptake in a polypoidal structure in the sinus sphenoidalis. When asked she had no related symptoms due to the sphenoid polyp and the CT-scan showed no bone destruction. To rule out malignancy a biopsy was made showing benign sinonasal papilloma of oncocytic origin. High 18F-FDG PET uptake can be seen in benign structures and should therefore not be the only predictor for malignancy.

  2. Approaching chronic sinusitis.

    PubMed

    Sarber, Kathleen M; Dion, Gregory Robert; Weitzel, Erik K; McMains, Kevin C

    2013-11-01

    Chronic sinusitis is a common disease that encompasses a number of syndromes that are characterized by sinonasal mucosal inflammation. Chronic sinusitis can be defined as two or more of the following symptoms lasting for more than 12 consecutive weeks: discolored rhinorrhea, postnasal drip, nasal obstruction, facial pressure or pain, or decreased sense of smell. Chronic sinusitis is further classified as chronic sinusitis with polyposis, chronic sinusitis without polyposis, or allergic fungal sinusitis using physical examination, and histologic and radiographic findings. Treatment methods for chronic sinusitis are based upon categorization of the disease and include oral and inhaled corticosteroids, nasal saline irrigations, and antibiotics in selected patients. Understanding the various forms of chronic sinusitis and managing and ruling out comorbidities are key to successful management of this common disorder.

  3. Endonasal surgery of the ventral skull base--endoscopic transcranial surgery.

    PubMed

    Bhatki, Amol M; Carrau, Ricardo L; Snyderman, Carl H; Prevedello, Daniel M; Gardner, Paul A; Kassam, Amin B

    2010-02-01

    Skull base surgery is evolving from traditional transfacial and transcranial approaches to the endoscopic endonasal approach, a less intrusive corridor for accessing the ventral skull base. This technique eliminates facial scars, expedites recovery, and obviates brain retraction. The goals of surgical excision, whether palliative or curative, are identical: an approach that is less disruptive to normal tissues. By exploiting the sinonasal corridor, the entire ventral skull base may be accessed to successfully treat benign and malignant lesions. The expanding limits of endoscopic skull base surgery have been accompanied by commensurate innovations in reconstructive techniques that are reliable and have been shown to limit postoperative complications. This article describes the basis for this approach and provides the latest outcome data supporting the current state of the art for endoscopic skull base surgery.

  4. [Late neck metastasis in esthesioneuroblastoma: a case report].

    PubMed

    Damar, Murat; Başerer, Nermin; Ozkara, Selvinaz; Yılmazer, Rasim

    2012-01-01

    Esthesioneuroblastoma is a rare malignancy of olfactory neuroepithelium arising from sinonasal region. It has biologically an aggressive behavior. The tumor is characterised by common local recurrence, atypic distant metastasis and poor long-term prognosis. Cervical metastasis accounts for 20-30% of the patients. Late metastases are seen particularly six months or later following primary treatment. In this article, we present a 43-year-old female case with Kadish B stage esthesioneuroblastoma who underwent extracranial tumor resection and postoperative radiotherapy. Eleven years later (at 132 months) right neck cervical metastasis was occurred and we applied right functional neck dissection and adjuvant radiotherapy to treat. We also review the treatment of late neck metastasis in the light of the current literature data.

  5. Cardiac involvement as the main presenting feature in eosinophilic granulomatosis with polyangiitis

    PubMed Central

    McAleavey, Neil; Millar, Auleen; Pendleton, Adrian

    2013-01-01

    Eosinophilic granulomatosis with polyangiitis is usually characterised by asthma, allergic rhinitis and peripheral eosinophilia. Presentations can vary greatly especially when there is cardiac involvement as demonstrated in these two case reports. Patient A initially presented to casualty with severe sinus pain and was diagnosed with severe sinonasal polyposis. After routine nasal polypectomy he had a cardiac arrest and was transferred to intensive care. Patient B presented to his general practitioner with a 4-week history of breathlessness, joint pain and a rash resulting in admission to hospital. Both patients had significant eosinophilia on routine bloods. High-sensitivity troponin T levels were raised in both; however, patient B's was significantly higher. Patient A had a large pericardial effusion on echo, the aspirate of which revealed numerous eosinophils. Patient B's echo was normal. Patient A's cardiac MRI was normal while Patient B's revealed myocarditis. Both were successfully treated with intravenous methylprednisolone and cyclophosphamide. PMID:23853013

  6. Intradiploic hematoma of the frontal bone with secondary exophthalmos in a mare.

    PubMed

    Kafarnik, Christiane; Donaldson, David; Payne, Richard; Holloway, Andrew

    2014-07-01

    A 13-year-old cob mare was presented with exophthalmos and periocular swelling of the left eye. The diagnostic work-up included ocular ultrasound, sonographic examination through the thinned frontal bone, radiography, standing computed tomography of the skull and exploratory osteoplastic surgery. Histopathology was consistent with an organized hematoma. An intradiploic hematoma of the frontal bone was diagnosed 5 years after head trauma, with progressive expansion and deformation of the skull resulting in exophthalmos. Exophthalmos with facial bone deformation was the only clinical finding of intradiploic hematoma. Standing computed tomography (CT) aided the diagnosis to differentiate intradiploic hematoma from other, more common causes of facial bone distortion associated with paranasal sinus diseases. Intradiploic hematoma of possible traumatic origin is a differential diagnosis for sinonasal disease and exophthalmos in the horse.

  7. Paraneoplastic syndromes in olfactory neuroblastoma

    PubMed Central

    Gabrych, Anna; Czapiewski, Piotr; Sworczak, Krzysztof

    2015-01-01

    Olfactory neuroblastoma (ONB) is a rare malignant neoplasm of sinonasal tract, derived from olfactory epithelium. Unilateral nasal obstruction, epistaxis, sinusitis, and headaches are common symptoms. Olfactory neuroblastoma shows neuroendocrine differentiation and similarly to other neuroendocrine tumors can produce several types of peptic substances and hormones. Excess production of these substances can be responsible for different types of endocrinological paraneoplastic syndromes (PNS). Moreover, besides endocrinological, in ONB may also occur neurological PNS, caused by immune cross-reactivity between tumor and normal host tissues in the nervous system. Paraneoplastic syndromes in ONB include: syndrome of inappropriate ADH secretion (SIADH), ectopic ACTH syndrome (EAS), humoral hypercalcemia of malignancy (HHM), hypertension due to catecholamine secretion by tumor, opsoclonus-myoclonus-ataxia (OMA) and paraneoplastic cerebellar degeneration. Paraneoplastic syndromes in ONB tend to have atypical features, therefore diagnosis may be difficult. In this review, we described initial symptoms, patterns of presentation, treatment and outcome of paraneoplastic syndromes in ONB, reported in the literature. PMID:26199564

  8. Hyperostotic Esthesioneuroblastoma: Rare Variant and Fibrous Dysplasia Mimicker

    PubMed Central

    Knott, Phillip Daniel

    2014-01-01

    A 65-year-old male presented with a 3-year history of orbital symptoms. An imaging-based diagnosis of fibrous dysplasia involving the skull base was made at another institution. CT showed a diffuse sinonasal mass and ground-glass appearance of the bones of the anterior skull base with bony defects and mucocele formation. MRI demonstrated an accompanying intracranial and orbital rind of soft tissue mass along the hyperostotic bones. FDG-PET showed corresponding intense hypermetabolism. Small cysts were observed at the tumor-brain interface. Biopsy revealed esthesioneuroblastoma with bone infiltration that is compatible with the hyperostotic variant of esthesioneuroblastoma. There are a few cases of hyperostotic esthesioneuroblastoma reported in the literature. PMID:24497807

  9. Nasal irrigation: From empiricism to evidence-based medicine. A review.

    PubMed

    Bastier, P-L; Lechot, A; Bordenave, L; Durand, M; de Gabory, L

    2015-11-01

    Nasal irrigation plays a non-negligible role in the treatment of numerous sinonasal pathologies and postoperative care. There is, however, a wide variety of protocols. The present review of the evidence-based literature sought objective arguments for optimization and efficacy. It emerged that large-volume low-pressure nasal douche optimizes the distribution and cleansing power of the irrigation solution in the nasal cavity. Ionic composition and pH also influence mucociliary clearance and epithelium trophicity. Seawater is less rich in sodium ions and richer in bicarbonates, potassium, calcium and magnesium than is isotonic normal saline, while alkaline pH and elevated calcium concentration optimized ciliary motility in vitro. Bicarbonates reduce secretion viscosity. Potassium and magnesium promote healing and limit local inflammation. These results show that the efficacy of nasal irrigation is multifactorial. Large-volume low-pressure nasal irrigation using undiluted seawater seems, in the present state of knowledge, to be the most effective protocol.

  10. Infantile Maxillary Sinus Osteomyelitis Mimicking Orbital Cellulitis

    PubMed Central

    Krishnan, Nagarajan; Ramamoorthy, Nathan; Panchanathan, Suresh; Balasundaram, Jothiramalingam S

    2014-01-01

    Periorbital soft tissue swelling may result due to primary orbital pathology or from adjacent facio-maxillary or sino-nasal inflammatory causes. Osteomyelitis of maxilla in the pediatric age group is a rare entity in this era of antibiotics. We present an 11-month-old female infant who was brought with peri-orbital selling and purulent nasal discharge. Computed Tomography showed erosions of the walls of maxillary sinus suggestive of osteomyelitis. Culture of sinus scraping showed Staphylococcus aureus growth and the child improved with intravenous cloxacillin therapy. This case is presented due to the rarity of its presentation in this age group and for awareness to consider this entity in children having fever and peri-orbital swelling. PMID:25191055

  11. Nasal mucosa: a new site for tissue biopsy to diagnose hereditary TTR amyloidosis.

    PubMed

    Munar-Qués, Miguel; Solé, Manel; Martínez-Nadal, Jacinto; Murcia-Sáiz, Antonio; Mas-Degano, José Manuel

    2014-11-07

    We report 2 carriers of the TTRV30M mutation and its plasmatic biochemical marker with clinical symptoms compatible with hereditary TTR amyloidosis. Based on our previously reported casual finding of amyloid TTR in nasal mucosa (2008), we requested biopsy of this tissue to search for amyloid with Congo red staining and TTR immunohistochemical analysis. The histological diagnosis was achieved by retrospective analysis of surgical sinonasal biopsy in the first patient and prospective biopsy of inferior nasal concha in the second. Large interstitial deposits of ATTR were observed in both cases. We suggest nasal mucosa as a suitable site for tissue biopsy in patients with suspected hereditary TTR amyloidosis. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  12. Sphenoid sinus organized hematoma with cranial neuropathies masquerading as a malignancy: A case report

    PubMed Central

    LIN, YU-HSUAN; WANG, PO-CHIN; LIN, YAOH-SHIANG

    2016-01-01

    Sinonasal organized hematoma (SNOH) is rarely encountered in clinical practice. The disease demonstrates a high tendency for occurrence in East Asian individuals, and in the majority of cases, is located in the maxillary sinus. The current report presents the case of an 81-year-old female who developed a space-occupying lesion, which masqueraded as a skull base malignancy, following surgery for the treatment of isolated sphenoid sinus aspergilloma. Subsequent endoscopic endonasal surgery confirmed the diagnosis of an OH of the sphenoid sinus. The patient recovered from all neurological deficits within two months, with the exception of the loss of visual perception. Although SNOH presents a diagnostic challenge, when physicians possess knowledge of its typical imaging features, this facilitates the achievement of a correct diagnosis and the prescription of optimal treatment. PMID:27284357

  13. Sphenoid sinus organized hematoma with cranial neuropathies masquerading as a malignancy: A case report.

    PubMed

    Lin, Yu-Hsuan; Wang, Po-Chin; Lin, Yaoh-Shiang

    2016-06-01

    Sinonasal organized hematoma (SNOH) is rarely encountered in clinical practice. The disease demonstrates a high tendency for occurrence in East Asian individuals, and in the majority of cases, is located in the maxillary sinus. The current report presents the case of an 81-year-old female who developed a space-occupying lesion, which masqueraded as a skull base malignancy, following surgery for the treatment of isolated sphenoid sinus aspergilloma. Subsequent endoscopic endonasal surgery confirmed the diagnosis of an OH of the sphenoid sinus. The patient recovered from all neurological deficits within two months, with the exception of the loss of visual perception. Although SNOH presents a diagnostic challenge, when physicians possess knowledge of its typical imaging features, this facilitates the achievement of a correct diagnosis and the prescription of optimal treatment.

  14. Gonadal histopathology following nickel intoxication in the giant gaurami Colisa fasciatus (Bloch and Schneider), a freshwater tropical perch

    SciTech Connect

    Nath, K.; Kumar, N. )

    1990-08-01

    Large variety of data regarding toxic effects of nickel on mammals has been reported. Nickel refinery workers had increased mortality from lung or sinonasal cancers. In human populations exposed to nickel and chromium compounds, chromosomal abberations have been reported. Biochemical as well as histopathological alterations arising from nickel exposure in mammals have also been documented. Very scanty data is available concerning histopathological impact of nickel on fish tissues. However, to the authors' knowledge, there are no reports available on the fish gonads of either sex encountered with nickel. The present study appears to be the first report on the topic. Therefore, in the present investigation impact of nickel on the histological architecture of gonads of both sexes of a freshwater tropical perch, Colisa fasciatus have been assessed.

  15. Immune Cell Responses and Mucosal Barrier Disruptions in Chronic Rhinosinusitis

    PubMed Central

    Khalmuratova, Roza; Park, Jong-Wan

    2017-01-01

    Chronic rhinosinusitis (CRS) is one of the most common presentations of upper airway illness and severely affects patient quality of life. Its frequency is not surprising given levels of environmental exposure to microbes, pollutants, and allergens. Inflammatory cells, inflammatory cytokine and chemokine production, and airway remodeling have been detected in the sinonasal mucosae of CRS patients, although the precise pathophysiological mechanisms causing such persistent inflammation remain unclear. Given its high prevalence and considerable associated morbidity, continued research into CRS is necessary to increase our understanding of factors likely to contribute to its pathogenesis, and facilitate the development of novel therapeutic strategies to improve treatment. The purpose of this review is to summarize the current state of knowledge regarding immune cell responses and epithelial alterations in CRS. PMID:28261021

  16. Renal cell carcinoma metastasis to the paranasal sinuses and orbit

    PubMed Central

    Evgeniou, Evgenios; Menon, Kavitha R; Jones, Graeme L; Whittet, Heiki; Williams, Wynne

    2012-01-01

    The authors report a rare case of renal cell carcinoma (RCC) metastasis to the paranasal sinuses. The authors review RCC and its potential for sinonasal metastasis and discuss the variable presentation and need for clinical suspicion for early diagnosis and treatment. A 74-year-old man presented with numbness of the left side of the face, reduced visual acuity and ptosis 12 years after nephrectomy for RCC. Imaging studies showed a lesion in the left pterygopalatine fossa and the histological features supported the diagnosis of metastatic RCC. RCC metastasis to the paranasal sinuses is very rare and can present with various symptoms depending on the affected organ. These symptoms occasionally are the initial manifestation of renal RCC and it is very important to recognise them so that the patient receives the appropriate therapy to improve survival. PMID:22605794

  17. Occult nasolacrimal duct ectasia in a child with acute sinusitis: clinicopathological considerations and literature review.

    PubMed

    Giordano, Davide; Gradoni, Paolo; Oretti, Gabriele; Cerasti, Davide; Ferri, Teore

    2015-09-14

    Enlargement of the nasolacrimal duct (NLD) in the absence of neoplasm is rare. As there are few reports on this condition in the literature, its pathologic significance and proper management remain unclear. We report a case of asymptomatic NLD enlargement incidentally discovered on high resolution computed tomography scan performed for a complicated acute sinusitis. Case report and literature review. NLD enlargement, defined as a truly isolated asymptomatic dilatation of the NLD, is rarely encountered. Etiology and clinical significance are unclear although the absence of nasolacrimal pathway or sinonasal disease and radiological findings of bone remodelling suggest that it may be congenital. In such cases, diagnosis may be incidental and based on imaging studies, and the term NLD ectasia seems to be more appropriate to describe this distinct entity. NLD enlargement may favour osteomeatal complex obstruction, thus leading to severe acute sinusitis.

  18. Radiotherapy-induced hypopituitarism: a review.

    PubMed

    Sathyapalan, Thozhukat; Dixit, Sanjay

    2012-05-01

    Hypopituitarism is a disorder caused by impaired hormonal secretions from the hypothalamic-pituitary axis. Radiotherapy is the most common cause of iatrogenic hypopituitarism. The hypothalamic-pituitary axis inadvertently gets irradiated in patients receiving prophylactic cranial radiotherapy for leukemia, total body irradiation and radiotherapy for intracranial, base skull, sinonasal and nasopharyngeal tumors. Radiation-induced hypopituitarism (RIH) is insidious, progressive and largely nonreversible. Mostly, RIH involves one hypothalamic-pituitary axis; however, multiple hormonal axes deficiency starts developing at higher doses. Although the clinical effects of the hypopituitarism are more profound in children and young adults, its implications in older adults are being increasingly recognized. The risk continues to persist or increase up to 10 years following radiation exposure. The clinical management of hypopituitarism is challenging both for the patients and healthcare providers. Here we have reviewed the scale of the problem, the risk factors and the management of RIH.

  19. Infarcted angiomatous nasal polyps.

    PubMed

    Sheahan, Patrick; Crotty, Paul L; Hamilton, Sam; Colreavy, Michael; McShane, Donald

    2005-03-01

    Angiomatous nasal polyps are a rarely reported subtype of inflammatory sinonasal polyps that are characterized by extensive vascular proliferation and ectasia. Compromise of their vascular supply may occasionally lead to infarction, resulting in clinical, radiological and pathological features that simulate a neoplastic process. In the present paper, the salient characteristics of this unusual entity are described. The clinical, radiological and pathological features of two patients with infarcted angiomatous nasal polyps are presented. Grossly, the polyps had an unusual inhomogenous appearance and texture and were associated with a foul odor. CT findings included bony expansion and destruction. MRI findings included markedly inhomogenous contrast enhancement on T1-weighted images. Histopathologically, both cases showed abundant vascular ectasia, with widespread intraluminal thrombosis and necrosis. Recanalization and reparative changes were also present. Angiomatous nasal polyps are poorly documented in the literature. Although entirely benign, they may simulate neoplastic processes, thus awareness of their existence is of considerable importance.

  20. Renal cell carcinoma metastasis to the paranasal sinuses and orbit.

    PubMed

    Evgeniou, Evgenios; Menon, Kavitha R; Jones, Graeme L; Whittet, Heiki; Williams, Wynne

    2012-03-27

    The authors report a rare case of renal cell carcinoma (RCC) metastasis to the paranasal sinuses. The authors review RCC and its potential for sinonasal metastasis and discuss the variable presentation and need for clinical suspicion for early diagnosis and treatment. A 74-year-old man presented with numbness of the left side of the face, reduced visual acuity and ptosis 12 years after nephrectomy for RCC. Imaging studies showed a lesion in the left pterygopalatine fossa and the histological features supported the diagnosis of metastatic RCC. RCC metastasis to the paranasal sinuses is very rare and can present with various symptoms depending on the affected organ. These symptoms occasionally are the initial manifestation of renal RCC and it is very important to recognise them so that the patient receives the appropriate therapy to improve survival.