National Cancer Institute®
Last Modified: April 1, 2002
UI - 11843651
AU - Baron JA; Raines J; Bangert J; Hansen RC
TI - Persistent nodule on the nose.
SO - Arch Dermatol 2002 Feb;138(2):259-64
AD - University of Arizona College of Medicine, Tucson, AZ, USA.
UI - 11905317
AU - Helman JI
TI - Maxillectomy.
SO - Atlas Oral Maxillofac Surg Clin North Am 1997 Sep;5(2):75-89
AD - Section of Oral and Maxillofacial Surgery, Department of Surgery (Medical School), Department of Oral Medicine, Pathology, and Maxillofacial Surgery (Dental School), University of Michigan, Ann Arbor, Michigan, USA.
UI - 11902539
AU - Dulguerov P; Allal A S; Calcaterra T C
TI - Esthesioneuroblastoma: a meta-analysis and review.
SO - Lancet Oncol 2001 Nov;2(11):683-90
AD - Division of Head and Neck Surgery, Geneva University Hospital, Switzerland. firstname.lastname@example.org
Our objective was to review recent developments in diagnosis, staging, and treatment of esthesioneuroblastoma (ENB). A meta-analysis of publications between 1990 and 2000 was carried out, and studies were classified according to their main subject: origin/aetiology of ENB, histopathological diagnosis, and treatment. Data so far point to the basal progenitor cells of the olfactory epithelium as the origin of ENB. Histopathological diagnosis remains difficult and is based on results of antigen expression detected through a panel of antibodies by immunohistochemistry. RT-PCR of HASH expression could be a specific marker of ENB. Overall and disease-free survival at 5 years averaged 45% (SD 22) and 41% (SD 21) in the studies included in the meta-analysis. Survival in Hyams' grades I-II was 56% (SD 20) compared with 25% (SD 20) in grades III-IV (odds ratio 6.2). In patients with metastases in cervical lymph nodes (on average 5% of the total) survival was 29%, compared with 64% for patients with N0 disease (odds ratio 5.1). Survival according to treatment modalities was 65% for surgery plus radiotherapy, 51% for radiotherapy and chemotherapy, 48% for surgery, 47% for surgery plus radiotherapy and chemotherapy, and 37% for radiotherapy alone. The histopathological grading according to Hyams and the presence of cervical lymph-node metastases emerged as prognostic factors. A combination of surgery and radiotherapy seems to be the optimum approach to treatment. The exact role of chemotherapy in treatment protocols is still unclear. The role of elective neck dissection is unclear.
UI - 11908335
AU - Duruisseau O; Yona L; Wagner I; Baglin AC; de Dieuleveult T; Chabolle F
TI - [Inverted papilloma: endoscopic versus external surgery. Apropos of 28 cases]
SO - Ann Otolaryngol Chir Cervicofac 2001 Dec;118(6):344-51
AD - Service d'ORL et chirurgie cervico faciale, Hopital Foch, 40, rue Worth, 92150 Suresnes, France.
To evaluate the role of endoscopic versus external surgery in the treatment of inverted papillomas, the clinical courses of 35 patients over a period of 10 years were reviewed. 13 patients were treated endoscopically whereas 15 were treated with an external approach. 7 patients with a post operative follow up of less than 12 months were excluded from the study. Recurrences occurred in 4 patients, 2 patients had been treated by endoscopic surgery and 2 by medial maxillectomy by lateral rhinotomy. 3 patients were diagnosed with squamous cell carcinoma. Salvage surgery was performed by an external procedure or endoscopically depending on the extension of the recurrence. Late complications occurred in both groups: cosmetic complaints and epiphora were more frequently encountered after external treatment. Functional complaints were noted after endoscopic treatment. If there is no evidence of associated malignancy, if complete exposure of the tumor is possible and long term follow up is feasible, the authors propose endoscopic surgery as first line treatment to excise the body of the tumor, assess it's extension, and remove the root of the tumor. If this is not the case, medial maxillectomy by external approach should be performed.
UI - 11819076
AU - Oddone M; Granata C; Dalmonte P; Biscaldi E; Rossi U; Toma P
TI - Nasal glioma in an infant.
SO - Pediatr Radiol 2002 Feb;32(2):104-5
AD - Department of Radiology, Giannina Gaslini Hospital for Sick Children, 16147 Genoa, Italy.
UI - 11770150
AU - Nguyen HN; Tewfik TL; Schloss MD; Frenkiel S; Bernard C
TI - Adenocarcinoma of the paranasal sinuses: two case reports in a child and an adolescent.
SO - J Otolaryngol 2000 Dec;29(6):389-92
AD - Department of Otolaryngology, McGill University, Montreal, Quebec.
UI - 11892044
AU - Bernstein JM
TI - The molecular biology of nasal polyposis.
SO - Curr Allergy Asthma Rep 2001 May;1(3):262-7
AD - Departments of Otolaryngology and Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA.
The molecular biologic events in the development of nasal polyps are now becoming unraveled. It appears that eosinophils are the dominant inflammatory cell present in this tissue. The events leading up to the extravasation of eosinophils into the lamina propria nasal polyps are regulated by the proinflammatory cytokines tumor necrosis factor-alpha and interleukin-1 beta. These cytokines upregulate very late antigen-4 on the surface of eosinophils and vascular cell adhesion molecule-1 on the surface of the endothelial blood vessel. Chemokines such as RANTES (regulated upon activation, normal T-cell expressed and secreted) and eotaxin are responsible for the movement of eosinophils into the lamina propria of the nasal polyp. The release of major basic protein has an effect on alteration of the epithelial architecture and on the sodium and chloride flux into and out of the apical epithelial cell of the tissue. Finally, the alteration of the surface epithelium results in a defect in the migration of the cystic fibrosis transmembrane regulator protein to the apical surface. These two events, the release of major basic protein from the eosinophil and the alteration of the architecture of the surface epithelium, lead to an increase in sodium absorption and resultant edema: the hallmark of the pathology of the nasal polyp.
UI - 11920504
AU - Nibu K; Sugasawa M; Asai M; Ichimura K; Mochiki M; Terahara A; Kawahara
TI - N; Asato H Results of multimodality therapy for squamous cell carcinoma of maxillary sinus.
SO - Cancer 2002 Mar 1;94(5):1476-82
AD - Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. email@example.com
BACKGROUND: A wide variety of modalities, including surgery, radiation therapy, and chemotherapy, alone or in combination, have been used for the treatment of squamous cell carcinoma (SCC) of the maxillary sinus to obtain better local control and maintain functions. However, there is still much controversy with regard to the optimum treatment. METHODS: From 1987 to 1999, 33 patients with SCC of maxillary sinus were treated at the Department of Otolaryngology-Head and Neck Surgery, University of Tokyo Hospital. The treatment consisted of 30-40 grays (Gy) of preoperative radiotherapy with concomitant intraarterial infusion of 5-fluorouracil and cisplatin followed by surgery and 30-40 Gy of postoperative radiotherapy, for tumors without skull base invasion. For tumors invading the skull base, preoperative systemic chemotherapy with or without radiotherapy was performed, instead of intraarterial chemotherapy, then followed by skull base surgery. The surgical procedures varied according to the extent of tumor. Results were compared with those of the 108 patients treated in our hospital from 1976 to 1982. RESULTS: Partial maxillectomy was performed in 2 T2 patients and 12 T3 patients. Total maxillectomy was performed in 1 T2 patient, 3 T2 patients, and 7 T4 patients. Skull base surgery was performed in eight T4 patients. Orbital content and hard palate were preserved in 22 patients and 18 patients, respectively. The overall 5-year survival rates were 86% in T 3 patients and 67 % in T4 patients, respectively. CONCLUSIONS: Our multimodal treatment has provided favorable local control and survival outcome with good functional results. Copyright 2002 American Cancer Society.
UI - 11844067
AU - Miura K; Mineta H; Yokota N; Tsutsui Y
TI - Olfactory neuroblastoma with epithelial and endocrine differentiation transformed into ganglioneuroma after chemoradiotherapy.
SO - Pathol Int 2001 Dec;51(12):942-7
AD - Division of Pathology, Second Department of Pathology, Hamamatsu University School of Medicine, Japan. firstname.lastname@example.org
We report a 56-year-old man in whom an olfactory neuroblastoma with epithelial and endocrine differentiation transformed into a mature ganglioneuroma after chemoradiotherapy. The tumor arising from the sphenoidal and maxillary sinuses showed rapid growth into the frontal lobe and metastasis to the cervical lymph nodes. The patient showed signs of a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). A radical craniofacial resection of the primary tumor was performed after 16 Gy of local irradiation and systemic chemotherapy. Three months after the operation, the patient died of mediastinal metastasis. The biopsy before chemoradiotherapy showed a neuroblastoma with Homer-Wright rosettes, fibrillary matrix, Flexner-Wintersteiner rosettes and antidiuretic hormone production. After chemoradiotherapy, the histology changed to that of a ganglioneuroma consisting of large ganglion cells and Schwann cells without immature neuroblastoma components. Although transformation to ganglioneuroma in an adrenal neuroblastoma is common, an olfactory neuroblastoma showing ganglioneuronal maturation after chemoradiotherapy has not been reported. The pluripotent progenitor cells of the olfactory neurons may be the origin and their existence explains why various neoplasms with neuronal and epithelial differentiation arise from the olfactory mucosa.
UI - 11891956
AU - Patel SG; Prasad ML; Escrig M; Singh B; Shaha AR; Kraus DH; Boyle JO;
TI - Huvos AG; Busam K; Shah JP Primary mucosal malignant melanoma of the head and neck.
SO - Head Neck 2002 Mar;24(3):247-57
AD - Head and Neck Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA. email@example.com
INTRODUCTION: The relative rarity of mucosal melanomas of the head and neck (MMHN) has made analysis of treatment approaches difficult. Advances in diagnostic techniques and treatment interventions have had obvious impact on outcomes in cutaneous melanoma, but the effects on outcome in MMHN remain undefined. This study aims to assess the outcome and identify clinical and histologic prognostic indicators in a recent cohort of patients with MMHN treated at a single institution. METHODS: The clinical records of 59 patients with the diagnosis of MMHN treated at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1978 and 1998 were retrospectively reviewed. Pathologic material on each of these patients was prospectively reviewed by at least two pathologists (MP, KB, or AH) for confirmation of diagnosis and assessment of histologic variables. Survival was calculated by the Kaplan-Meier method. Clinical (patient demographics, tumor characteristics, and treatment) and histologic data (tumor thickness, melanosis, melanoma in situ, vascular invasion, and multifocality) were analyzed for impact on outcome by both univariate and multivariate analyses. RESULTS: Thirty-five patients (59%) had sinonasal tumors (SNMM), whereas 24 (41%) had oral (ORMM) tumors. Forty-seven patients (79.6%) were staged as stage I, 8 (13.6%) as stage II, and 4 (6.8%) were classified as stage III. Regional lymphatic metastases at presentation were more frequent in ORMM compared with SNMM (25% vs 6%, p =.05). Surgery was used in all patients. Adjuvant radiation therapy was used more frequently in the SNMM group compared with the ORMM group (40% vs 17%, p =.04). The rates of local failure for ORMM and SNMM were 51% and 50%, nodal failure rates were 42% and 20%, and distant failure rates were 67% and 40%, respectively (p = NS). With a median follow-up of 20 months, the 5-year disease-specific survival rate was 44% (40% for ORMM vs 47% for SNMM, p = NS). Significant prognostic factors for disease-specific survival on univariate analysis included advanced clinical stage at presentation, tumor thickness greater than 5 mm, presence of vascular invasion, and development of nodal and distant metastases. On multivariate analysis, however, regional nodal failure lost significance. CONCLUSIONS: Clinical stage at presentation, tumor thickness greater than 5 mm, vascular invasion on histologic studies, and development of distant failure are the only independent predictors of outcome in MMHN. Copyright 2002 Wiley Periodicals, Inc.
UI - 11891959
AU - Kummer E; Rasch CR; Keus RB; Tan IB; Balm AJ
TI - T stage as prognostic factor in irradiated localized squamous cell carcinoma of the nasal vestibule.
SO - Head Neck 2002 Mar;24(3):268-73
AD - Department of Head & Neck Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands.
BACKGROUND: To investigate the impact of T stage according to Wang on the prognosis of irradiated nasal vestibule carcinoma. PATIENTS AND METHODS: Treatment results of 47 patients were retrospectively analyzed. Treatment consisted of external beam radiotherapy (n = 26) or interstitial radiotherapy (n = 19) or a combination of both (n = 2) for a primary, localized, squamous cell carcinoma of the nasal vestibule. Mean follow-up was 5 years and 7 months. RESULTS: T1/T2 tumors: Local control was achieved in 40 of 44 patients; surgical salvage was possible in 2 of 4 local failures. Five patients had recurrences in the neck, and four of them could be salvaged surgically. One patient had distant metastases develop. T3 tumors (n = 3): no T3 tumor could locally be cured by radiotherapy. One patient was salvaged surgically but died of regional and distant metastases. Disease-specific survival is significantly correlated with T stage according to Wang (p =.0001). Most (85%) patients were smokers, and eight of them (20%) had a second primary tumor develop in the lungs. CONCLUSIONS: The effect of radiotherapy is significantly correlated with T stage (p =.0001) and hence less successful in T3 lesions as primary treatment option. The high incidence of second primary tumors in the lung is indicative for a similar carcinogenic influence of smoking on the nasal vestibule. Copyright 2002 Wiley Periodicals, Inc.
UI - 11861994
AU - Aung TH; Po YC; Wong WK
TI - Hepatocellular carcinoma with metastasis to the skull base, pituitary gland, sphenoid sinus, and cavernous sinus.
SO - Hong Kong Med J 2002 Feb;8(1):48-51
AD - Department of Neurosurgery, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Kowloon, Hong Kong.
Two cases of hepatocellular carcinoma, with metastases to the skull base, pituitary gland, sphenoid sinus, and cavernous sinus are reported. Patients presented with diplopia, retro-orbital headache, and multiple cranial nerves palsies. Pituitary metastases may require surgery as palliative treatment, and for the confirmation of histology. One of the current cases was diagnosed with hepatocellular carcinoma prior to transphenoidal resection of the pituitary metastasis. The second patient was found to have hepatocellular carcinoma after review of histology, and the development of signs and symptoms relating to the primary tumour.
UI - 11772496
AU - Mizokami H; Inokuchi A; Sawatsubashi M; Takagi S; Tsuda K; Tokunaga O
TI - Adenoid cystic carcinoma of the lacrimal gland with wide and severe myoepithelial differentiation.
SO - Auris Nasus Larynx 2002 Jan;29(1):77-82
AD - Department of Otolaryngology-Head and Neck Surgery, Saga Medical School, Saga 849-8501, Japan.
Adenoid cystic carcinoma (ACC) of the lacrimal gland is the second most common epithelial tumor for which different biologic courses can be predicted by histologic criteria. Three main types of growth patterns, cribriform; tubular; and solid have been identified. Tumors with solid components frequently follow a more aggressive clinical course and show worse prognosis than those with other patterns. We herein report a case of ACC with wide and severe myoepithelial differentiation arising from the lacrimal gland and presenting with aggressive clinical behavior. Postoperative radiotherapy may be the treatment of choice to control residual lesions and provide long-term survival even in the case of incomplete resection. Despite extensive surgery and radiation therapy, the prognosis of these tumors, especially with solid components, remains extremely poor. Accurate diagnosis is important because tumor histopathology is generally believed to be the most significant factor in patient survival.
UI - 8663944
AU - Mostafa BE
TI - Fluticasone propionate is associated with severe infection after endoscopic polypectomy.
SO - Arch Otolaryngol Head Neck Surg 1996 Jul;122(7):729-31
AD - Department of Otorhinolaryngology, Ain-Shams University, Cairo, Egypt.
OBJECTIVE: To test whether the use of fluticasone dipropionate nasal spray after endoscopic ethmoidectomy for multiple polyps is associated with a high incidence of infection. DESIGN. Randomized control study comparing the incidence of infection with the use of beclomethasone dipropionate or fluticasone propionate nasal spray after functional endoscopic sphenoethmoidectomy. Patients were followed up for 6 to 12 months. PATIENTS AND METHODS: Sixty patients with recurrent bilateral nasal polyps underwent functional endoscopic sphenoethmoidectomy and were then randomly allocated into 2 groups of 30 patients each. One group received beclomethasone dipropionate spray (100 micrograms in each nostril every 12 hours), and the other group received fluticasone propionate spray (100 micrograms/d in each nostril). RESULTS: In the fluticasone propionate group, 6 patients (20%) developed acute gram-positive pansinusitis requiring hospitalization and discontinuation of treatment. CONCLUSION: The use of fluticasone dipropionate aqueous nasal spray for the postoperative control of recurrent nasal polyps seems to be associated with a high incidence of acute pansinusitis.
UI - 9087151
AU - Holmberg K; Juliusson S; Balder B; Smith DL; Richards DH; Karlsson G
TI - Fluticasone propionate aqueous nasal spray in the treatment of nasal polyposis.
SO - Ann Allergy Asthma Immunol 1997 Mar;78(3):270-6
AD - Department of Otorhinolaryngology, Molndal Hospital, Sweden.
BACKGROUND: Topical glucocorticoids are the medical treatment of choice in a majority of patients suffering from nasal polyposis. Fluticasone propionate is a fluorinated steroid reported to be highly effective when used topically in the nose for seasonal and perennial allergic and nonallergic rhinitis. OBJECTIVES: To evaluate the efficacy and tolerability of intranasal fluticasone propionate in the treatment of long-standing polyposis. METHODS: Fifty-five patients with long-standing nasal polyposis were treated over a 26-week period with fluticasone propionate aqueous nasal spray 200 micrograms bid, beclomethasone dipropionate aqueous nasal spray 200 micrograms bid or placebo, administered intranasally in an aqueous spray in a double-blind, placebo-controlled parallel-group design at a single center. The primary efficacy endpoint was the physicians' assessment of symptoms and polyp score. Peak nasal inspiratory flow was performed twice daily and on every visit to evaluate the effect of the corticosteroids on nasal air flow. RESULTS: A significant difference in the primary efficacy endpoint between fluticasone propionate aqueous nasal spray and beclomethasone dipropionate aqueous nasal spray compared with placebo was seen after 14 weeks of treatment. This was further verified by the peak nasal inspiratory flow results. There was some evidence of earlier onset in the fluticasone propionate aqueous nasal spray group compared with the beclomethasone dipropionate aqueous nasal spray group after 4 weeks in terms of the primary efficacy endpoint. From the daily record cards patients receiving fluticasone propionate aqueous nasal spray had a significantly higher percentage of days on which they required no rescue medication (P < .009) and a higher percentage of days with an overall nasal blockage score on waking of < 2 (P < .013) when compared with placebo-treated patients. No other statistically significant results were found between the two active compounds. CONCLUSION: Fluticasone propionate aqueous nasal spray 200 micrograms bid and beclomethasone dipropionate aqueous nasal spray 200 micrograms bid are effective in treating the symptoms of nasal polyps, with some evidence that fluticasone propionate aqueous nasal spray has a faster onset of action and is tolerated at least as well as beclomethasone dipropionate aqueous nasal spray at the same dose.
UI - 9129872
AU - Wiseman LR; Benfield P
TI - Intranasal fluticasone propionate. A reappraisal of its pharmacology and clinical efficacy in the treatment of rhinitis.
SO - Drugs 1997 May;53(5):885-907
AD - Adis International Limited, Auckland, New Zealand. firstname.lastname@example.org
The intranasal corticosteroid fluticasone propionate is an effective agent for the treatment of rhinitis, demonstrating potent local anti-inflammatory activity and little, if any, systemic activity. Intranasal fluticasone propionate has shown clinical efficacy similar to that of other intranasal corticosteroids, including beclomethasone (administered at up to a 2-fold higher dosage than fluticasone), budesonide, flunisolide and triamcinolone acetonide, and provides greater relief from nasal symptoms (including nasal blockage) than antihistamine agents and intranasal sodium cromoglycate. Its efficacy in the treatment of seasonal allergic rhinitis and perennial allergic and nonallergic rhinitis has been demonstrated in large well-controlled studies in which the drug maintained adequate control of symptoms when administered in a once daily dose of 200 micrograms. In addition, fluticasone propionate has shown similar efficacy to that of beclomethasone in the treatment of nasal polyps; however, its use in the postoperative setting requires further investigation. Intranasal fluticasone propionate is well tolerated in the majority of patients, the incidence of adverse events being similar to that seen with placebo. Pharmacoeconomic analyses indicate that intranasal fluticasone propionate is significantly more cost-effective than the antihistamines terfenadine and loratadine. Overall quality of life was improved to a similar extent by fluticasone propionate and beclomethasone. In conclusion, recent clinical experience has confirmed that intranasal fluticasone propionate is a convenient, effective and well tolerated alternative to other intranasal corticosteroids and antihistamines for the treatment of rhinitis when administered once daily.
UI - 9604976
AU - Lund VJ; Flood J; Sykes AP; Richards DH
TI - Effect of fluticasone in severe polyposis.
SO - Arch Otolaryngol Head Neck Surg 1998 May;124(5):513-8
AD - Institute of Laryngology and Otology, Royal National Throat, Nose and Ear Hospital, London, England.
OBJECTIVES: To investigate the effect of intranasal corticosteroids in the treatment of polyps in patients with severe polyposis listed for surgical treatment and to determine the treatment effect on the progression of the disease. DESIGN: A double-blind, randomized, parallel-group, placebo-controlled, 12-week study at a single center. SETTING: A tertiary referral center in London, England. PATIENTS: Thirty-four patients with severe polyposis listed for endoscopic surgical treatment. INTERVENTION: By random allocation, fluticasone propionate aqueous nasal spray (FPANS), 200 microg twice a day; beclomethasone dipropionate aqueous nasal spray, 200 microg twice a day; or placebo nasal spray twice a day was administered. Patients received 2 actuations to each nostril in the morning and in the evening. MAIN OUTCOME MEASURES: Efficacy end points were the need for polypectomy at the end of treatment, the results of acoustic rhinometry, the polyp score, the peak nasal inspiratory flow rate, and an assessment of symptoms. RESULTS: The polyp score was significantly decreased in the FPANS-treated group (P < or = .01). The nasal cavity volume was significantly increased in both the FPANS-treated group and the group receiving beclomethasone compared with placebo (P < or = .01) at the end of treatment. The percentage change in the mean morning peak nasal inspiratory flow rate was greater in the FPANS-treated group, with a significant effect observed at week 2 (P = .01). Nasal blockage was significantly decreased in both active groups compared with the group receiving placebo. No significant difference was observed between the treatment groups in the number of patients requiring polypectomy. CONCLUSIONS: Fluticasone and beclomethasone aqueous nasal sprays are effective in treating the symptoms of severe nasal polyps. There was some evidence that the group treated with FPANS responded more quickly to intervention and that the magnitude of the response was greater than in the group receiving beclomethasone.
UI - 9794620
AU - Ishibashi T; Tanaka T; Nibu K; Ishimoto S; Kaga K
TI - Keratinocyte growth factor and its receptor messenger RNA expression in nasal mucosa and nasal polyps.
SO - Ann Otol Rhinol Laryngol 1998 Oct;107(10 Pt 1):885-90
AD - Department of Otolaryngology, Tokyo University Branch Hospital, Japan.
To examine the potential biologic role of fibroblast growth factors (FGFs) in nasal polyps and nasal mucosa during chronic inflammatory conditions, we investigated messenger RNA (mRNA) expression of three members of the FGF family -- acidic FGF, basic FGF, and keratinocyte growth factor (KGF)-- in nasal polyp tissues, as well as in hyperplastic nasal mucosa. Using the sensitive method reverse transcription-polymerase chain reaction (RT-PCR), we demonstrated that of the examined FGFs, KGF had the most abundant mRNA expression in nasal polyps and nasal mucosa. We also found that significantly higher levels of KGF mRNA were expressed in nasal polyps than in nasal mucosa, whereas mRNA expression of acidic FGF and basic FGF was relatively low in these tissues. In addition, we showed that KGF receptor mRNA was present in most of the nasal mucosa; however, none or little was expressed in nasal polyps. These results suggest that KGF might play an important role in nasal epithelial proliferation and that excessive synthesis of KGF in nasal polyp stroma may contribute to hypertrophy of the nasal mucosa in patients with chronic sinusitis associated with nasal polyposis.
UI - 9893189
AU - Hamilos DL; Thawley SE; Kramper MA; Kamil A; Hamid QA
TI - Effect of intranasal fluticasone on cellular infiltration, endothelial adhesion molecule expression, and proinflammatory cytokine mRNA in nasal polyp disease.
SO - J Allergy Clin Immunol 1999 Jan;103(1 Pt 1):79-87
AD - Department of Medicine , Washington University School of Medicine, St Louis, MO 63110, USA.
BACKGROUND: Nasal polyp (NP) disease demonstrates a gradual response to treatment with intranasal steroids. We hypothesized that various inflammatory features that promote NP eosinophilia would show a differential sensitivity to treatment with intranasal fluticasone. OBJECTIVES: We conducted a double-blind, placebo-controlled trial of 4 weeks of intranasal fluticasone propionate or matching placebo to assess their effectiveness in reducing NP inflammatory cells, expression of endothelial vascular cell adhesion molecule (VCAM)-1 and P-selectin, and expression of cytokines involved in induction of a group of adhesion molecules (ie, IL-4, IL-13, TNF-alpha, and IL-1beta). METHODS: Twenty subjects (9 women and 11 men) with severe chronic sinusitis and NP were studied. Systemic and intranasal steroids were withheld for a minimum of 1 month and 2 weeks, respectively, before the study. Biopsy specimens of NPs were obtained 1 week before and 4 weeks after treatment with intranasal fluticasone 100 microg or placebo per nostril administered twice daily. Biopsy specimens were snap frozen for immunostaining or fixed in paraformaldehyde for in situ hybridization. Pretreatment to posttreatment results were analyzed with Wilcoxon's signed-rank test. RESULTS: Fluticasone treatment significantly reduced NP eosinophilia (P =.02) and CD4(+) T lymphocytes (P =.02). Eosinophils expressing the marker EG2 were more significantly reduced (P =.007). Fluticasone also reduced the expression of P-selectin (P =.005) and the number of IL-4 and IL-13 mRNA+ cells (P =.02 and.05, respectively). In contrast, fluticasone did not significantly reduce expression of endothelial VCAM-1 or the number of TNF-alpha or IL-1beta mRNA+ cells in the polyps. CONCLUSIONS: We conclude that intranasal fluticasone reduced NP inflammation but that expression of proinflammatory cytokines and endothelial VCAM-1 were relatively unaffected by fluticasone treatment. These latter inflammatory features may contribute to the persistence of NP disease despite intranasal steroid treatment.
UI - 10334231
AU - Saunders MW; Wheatley AH; George SJ; Lai T; Birchall MA
TI - Do corticosteroids induce apoptosis in nasal polyp inflammatory cells? In vivo and in vitro studies.
SO - Laryngoscope 1999 May;109(5):785-90
AD - Department of Otolaryngology-Head and Neck Surgery, University of Bristol, United Kingdom.
OBJECTIVE/HYPOTHESIS: Corticosteroids are an effective treatment for nasal polyposis. The exact mechanism of action is not certain. Recent research demonstrates that apoptosis (programmed cell death) in inflammatory cells is an important factor in the resolution of inflammation, and apoptosis is induced in eosinophils in cell culture with steroids. We hypothesized that inflammatory cell apoptosis is a key feature of regression of nasal polyps on exposure to steroids and examined this hypothesis in vivo and in vitro. METHODS: A double-blind, placebo-controlled pilot study of fluticasone propionate aqueous nasal spray (FPANS) in nasal polyposis in humans in vivo was undertaken, and the effect of treatment on indices of cell death and proliferation measured. In addition, explants of nasal polyp tissue were maintained in vitro in short-term tissue culture with dexamethasone at increasing doses (0.1-50 micromol) over varying time intervals and then analyzed for similar indices of proliferation and cell death. RESULTS: Apart from a marginal increase in apoptotic:mitotic ratio in epithelium, little difference between the effect of FPANS and placebo was demonstrated in vivo. However, in vitro, apoptotic index was significantly increased in the stromal layers in relation to time of incubation (P = .0169), and a significant dose-response relationship was demonstrated at 24 hours between stromal cell apoptosis and dexamethasone concentration (P = .001). Eosinophil apoptosis was confirmed by in situ end labeling and transmission electron microscopy. No steroid or time effect on epithelial cells was demonstrated in vitro. CONCLUSION: Corticosteroids induce apoptosis in inflammatory cells in human nasal polyps in vitro. This is not reflected by a similar response to FPANS at 14 days in vivo, but may still play a part in regression of polyps with other forms of administration or at other time points.
UI - 10442547
AU - Holmstrom M
TI - Clinical performance of fluticasone propionate nasal drops.
SO - Allergy 1999;54 Suppl 53():21-5
AD - Department of Otorhinolaryngology, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
The efficacy and safety of fluticasone propionate (FP) nasal drops were investigated in two multicentre, randomized, placebo-controlled trials. Patients received FP 400 microg once or twice daily for 12 weeks and then FP 400 microg once daily for a further 12 weeks. FP 400 microg significantly reduced polyp size and improved peak nasal inspiratory flow, rhinitis symptoms and sense of smell when administered twice daily. Significant reductions in polyp size were not achieved with once daily administration, but clinical benefits were observed for peak nasal inspiratory flow. Both dosing regimens were well tolerated, with an overall incidence of adverse events which was similar to placebo.
UI - 10606936
AU - Penttila M; Poulsen P; Hollingworth K; Holmstrom M
TI - Dose-related efficacy and tolerability of fluticasone propionate nasal drops 400 microg once daily and twice daily in the treatment of bilateral nasal polyposis: a placebo-controlled randomized study in adult patients.
SO - Clin Exp Allergy 2000 Jan;30(1):94-102
AD - Tampere University Hospital, Tampere, Finland.
BACKGROUND: Topical corticosteroids are the accepted medical adjunct to surgery in patients suffering from nasal polyposis. Fluticasone propionate (FP) is a potent, topically active corticosteroid which has been formulated as nasal drops specifically for the treatment of polyposis. OBJECTIVES: To evaluate dose-related efficacy and tolerability of FP nasal drops (FPND) in the treatment of mild to moderate bilateral polyposis; in a double-blind, placebo-controlled, multicentre international study. METHODS: Adult patients (n = 142) with bilateral nasal polyps were randomized to receive either FPND 400 microg once daily (o.d.), FPND 400 microg twice daily (b.i.d.) or placebo for 12 weeks. The majority then entered a further 12 week open period during which all patients received FPND 400 microg o.d. The primary efficacy endpoint was the physicians' visual assessment of polyp size. Secondary clinical endpoints were nasal blockage and overall rhinitis (0-3 scores), peak nasal inspiratory flow (PNIF), olfactory function tests, and requirement for polypectomy. The patients also kept twice daily records of symptom scores, peak nasal inspiratory flow (PNIF) and use of rescue medication. RESULTS: At the end of the 12 week randomized treatment period, polyp size was reduced significantly by FPND 400 microg b.i.d. as compared with placebo (P = 0.006). Clinical assessments of nasal blockage and overall rhinitis showed significant improvements at several stages of treatment with both doses of FPND. Clinic PNIF was also improved significantly by both doses of FPND in comparison with placebo, and FPND 400 microg b.i.d. was significantly more effective than 400 microg o.d. (P = 0.045). Patient diary card scores supported the clinical assessments. Two patients on placebo required polypectomy and all treatments were well tolerated with a similar incidence of adverse events. CONCLUSION: FPND 400 microg once or twice daily is an effective and well-tolerated treatment for bilateral nasal polyposis.
UI - 10998024
AU - Keith P; Nieminen J; Hollingworth K; Dolovich J
TI - Efficacy and tolerability of fluticasone propionate nasal drops 400 microgram once daily compared with placebo for the treatment of bilateral polyposis in adults.
SO - Clin Exp Allergy 2000 Oct;30(10):1460-8
AD - McMaster University Medical Centre, Hamilton, Ontario, Canada, Paijat-Hame Hospital, Lahti, Finland, GlaxoWellcome Research & Development, UK.
BACKGROUND: Chronic eosinophilic rhinosinusitis underlies a range of respiratory disorders including nasal polyposis. Surgical and medical methods are used to control polyps, with topical steroids commonly being used for their anti-inflammatory properties. Fluticasone propionate nasal drops (FPND) is a formulation developed specifically for an effective and well tolerated corticosteroid treatment of nasal polyposis. OBJECTIVES: To assess efficacy and tolerability of FPND in the treatment of bilateral nasal polyposis in adults. METHODS: This multicentre, randomized, parallel-group study compared FPND 400 microgram once daily (o.d.) with placebo for 12 weeks in adult patients with mild to moderate bilateral polyposis. The primary efficacy endpoint was visual assessment of polyp size by the physician at monthly clinic visits. Nasal blockage, rhinitis, peak nasal inspiratory flow (PNIF), olfactory function and requirement for polypectomy were also assessed at visits. The patients kept diary card records of symptoms, PNIF, and use of rescue antihistamine. Additional safety data were provided by a 12-week open extension, when all patients received FPND 400 microgram o.d. RESULTS: After 12 weeks double-blind treatment with FPND (n = 52) or placebo (n = 52), polyp size was reduced in 27% and 16% of patients, respectively; clinical reduction of nasal blockage significantly favoured FPND over placebo (55% vs 22%; P = 0.002), and clinic PNIF had increased significantly with FPND (by 52 L/min vs -3 L/min for placebo; P < 0.001). Diary card measurements showed significant benefits of FPND vs placebo for daily PNIF, nasal blockage, rhinitis and use of loratadine rescue medication. Both treatments were well tolerated and no serious adverse events occurred during randomized treatment. Epistaxis was more frequent with FPND than placebo but was generally mild and did not result in withdrawals. Mean serum cortisol levels did not change significantly with either treatment. CONCLUSION: This study showed FPND 400 microgram o.d. to be an effective and well tolerated treatment for bilateral nasal polyposis in adults.
UI - 11447383
AU - Hamilos DL; Leung DY; Muro S; Kahn AM; Hamilos SS; Thawley SE; Hamid QA
TI - GRbeta expression in nasal polyp inflammatory cells and its relationship to the anti-inflammatory effects of intranasal fluticasone.
SO - J Allergy Clin Immunol 2001 Jul;108(1):59-68
AD - Departments of Medicine and Otolaryngology, Ear, Nose and Throat Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
BACKGROUND: Nasal polyposis disease is an inflammatory disorder with intense eosinophilic infiltration of respiratory mucosa that is often difficult to control with topical steroids. Recent evidence suggests that overexpression of the glucocorticoid receptor splice variant GRbeta in inflammatory cells might contribute to steroid insensitivity in diseases such as asthma. OBJECTIVE: The purposes of this investigation were to determine whether nasal polyp (NP) inflammatory cells overexpress GRbeta and to examine whether GRbeta overexpression is associated with insensitivity to the potent topical steroid fluticasone propionate (FP). METHODS: Biopsies were obtained from 10 subjects with NPs before and 4 weeks after treatment with intranasal FP. Middle turbinates biopsies from 6 healthy, nonallergic subjects served as normal controls. Biopsies were immunostained for inflammatory cell markers as well as GRbeta and probed for various cytokine mRNA. The anti-inflammatory response to FP was examined in relation to pretreatment levels of GRbeta expression. RESULTS: The total numbers of inflammatory cells were increased in NPs. The percentage of inflammatory cells expressing GRbeta was also increased (40.5% +/- 19.2% vs 16.1% +/- 4.0%, P =.009). GRbeta expression in NPs was almost exclusive to T lymphocytes, eosinophils, and macrophages. An inverse correlation was observed between the baseline inflammatory cell GRbeta expression and the reduction after FP treatment in EG2-positive eosinophils, CD4-positive T lymphocytes, endothelial VCAM-1 expression, and IL-4 mRNA-positive cells. NPs that were "FP-insensitive" in terms of suppression of eosinophil numbers (major basic protein-positive) had a significantly greater percentage of GRbeta-positive inflammatory cells, a higher ratio of GRbeta-positive/GRalpha-positive cells, and increased numbers of GRbeta-positive eosinophils and macrophages in comparison with those that were "FP-sensitive." "FP-insensitive" NPs also demonstrated a higher percentage of IL-5-positive inflammatory cells expressing GRbeta before and after FP treatment. CONCLUSION: GRbeta expression appears to be a marker of steroid insensitivity in NPs. Expression of GRbeta by NP inflammatory cells, particularly T cells and eosinophils, might render them resistant to suppression by topical steroids and thereby contribute to persistent NP inflammation.
UI - 11753306
AU - Pigno MA
TI - Conventional prosthetic rehabilitation after free flap reconstruction of a maxillectomy defect: a clinical report.
SO - J Prosthet Dent 2001 Dec;86(6):578-81
AD - The University of Texas Health Science Center at San Antonio, Texas 78229-3900, USA. email@example.com
Microvascular free flap reconstruction of maxillectomy defects has been advocated as a more desirable treatment option than conventional prosthetic rehabilitation. Free flap reconstruction can successfully separate the oral and sinonasal cavities, but the reconstructed defect may not improve the treatment outcome when compared with conventional prosthetic rehabilitation of a nonsurgically reconstructed defect. In this report, the prosthetic management of a patient who underwent immediate microvascular free flap reconstruction of a unilateral maxillectomy defect is described, and the issue of surgical versus nonsurgical reconstruction is discussed.
UI - 11926916
AU - Steele MH; Suskind DL; Moses M; Kluka E; Liu DC
TI - Orbitofacial masses in children: an endoscopic approach.
SO - Arch Otolaryngol Head Neck Surg 2002 Apr;128(4):409-13
AD - Division of Otolaryngology, University of Chicago, 5841 S Maryland Ave, MC1035, Chicago, IL 60637, USA.
OBJECTIVE: To describe an endoscopic approach for pediatric orbitofacial masses. DESIGN: A retrospective medical chart review. SETTING: Tertiary-care children's hospital. PARTICIPANTS: Patients (4 boys, 7 girls) ranged in age from 6 months to 11 years. All children underwent endoscopic excision of an orbitofacial mass. INTERVENTION: A single port approach was used in all but the initial case. The scalp incision was placed approximately 2.0 cm behind the frontal hairline. A subgaleal dissection was performed to minimize risk of nerve injury. Under endoscopic visualization, the mass was resected. MAIN OUTCOME MEASURES: Ability to successfully excise the mass endoscopically, and the incidence of complication. RESULTS: All lesions were successfully resected endoscopically. The surgical time varied from 30 to 105 minutes (mean, 50.5 minutes). Pathologic examination revealed 10 dermoid cysts and 1 neurofibroma. Two children had transient frontalis branch palsies that resolved spontaneously. There was 1 unilateral frontal hypoesthesia in the patient with the neurofibroma (an expected result). There were no other complications. CONCLUSIONS: An endoscopic approach to pediatric orbitofacial tumors is safe and effective. Although the risk of nerve injury may be higher, a thorough knowledge of frontotemporal anatomy and careful dissection will minimize this risk. The distinct advantage of an endoscopic approach is the absence of any facial scar in these young patients.
UI - 11926922
AU - Zur KB; Brandwein M; Wang B; Som P; Gordon R; Urken ML
TI - Primary description of a new entity, renal cell-like carcinoma of the nasal cavity: van Meegeren in the house of Vermeer.
SO - Arch Otolaryngol Head Neck Surg 2002 Apr;128(4):441-7
AD - Box 1189, Mount Sinai School of Medicine, 1 Gustave Levy Pl, New York, NY 10021, USA.
BACKGROUND: Few sinonasal malignancies can manifest, histologically, as clear cell neoplasia. The most likely such tumor to be encountered is metastatic renal cell carcinoma. Primary sinonasal tumors that can appear as clear cell malignancies include squamous cell carcinoma and mucoepidermoid carcinoma. Primary salivary clear cell carcinoma occurs almost exclusively in the oral cavity and has not been described in the nasal cavity. OBJECTIVE: To report a unique sinonasal clear cell malignancy that mimicked metastatic renal carcinoma. STUDY DESIGN: Case report. OUTCOME MEASUREMENTS: Radiography, histology, histochemistry, immunohistochemistry, and electron microscopy. RESULTS: Histologically, the tumor was identical to renal cell carcinoma. No evidence of renal malignancy was found by abdominal computed tomographic scan or gadolinium-enhanced magnetic resonance imaging. Histochemistry confirmed the presence of tumor glycogen but no mucin. Immunohistochemistry confirmed strong expression of low- and high-molecular-weight keratin and S100, and no vimentin expression. Electron microscopy showed tumor myofibroblastic differentiation and cytoplasmic glycogen, neutral lipid vacuoles, and cholesterol. CONCLUSIONS: There was no clinical evidence of renal cell carcinoma. The immunohistochemical and ultrastructural findings were inconsistent with the diagnosis of renal cell carcinoma and showed features also inconsistent with the diagnosis of primary salivary clear cell carcinoma. We therefore conclude that this tumor represents a new and distinct entity, notable in its presentation as a "counterfeit renal cell carcinoma."
UI - 11928098
AU - Umeda M; Minamikawa T; Yokoo S; Komori T
TI - Metastasis of maxillary carcinoma to the parapharyngeal space: rationale and technique for concomitant en bloc parapharyngeal dissection.
SO - J Oral Maxillofac Surg 2002 Apr;60(4):408-13; discussion 413-4
AD - Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. firstname.lastname@example.org
PURPOSE: En bloc resection of the primary tumor and regional lymph nodes is the classic method of surgery in cases of head and neck cancer, but it is not performed in cases of carcinoma of the maxillary gingiva or antrum for anatomic reasons. One of the reasons for the poor prognosis of patients with maxillary cancer and N+ stage necks is thought to be recurrence in the parapharyngeal space, which is out of the surgical field in radical neck dissection. The purpose of this study was to