Endonasal dacryocystorhinostomy: a prospective study

Objective

The objectives of this study are to report the results of Endonasal Dacryocystorhinostomy (EnDCR) and the role of silicon intubation in EnDCR in Indian population.

Study design

The authors conducted a prospective case series.

Methods

290 patients underwent EnDCR between January 2002 and July 2007 — 240 cases without silicon intubation and 50 cases with silicon intubation. Patients were followed up for an average of 18.6 months in first group and 5.2 months in second group. Outcome was evaluated subjectively and objectively.

Results

In EnDCR without silicon intubation, the procedure was successful in 93.3% of cases. In EnDCR with silicon intubation, the procedure was successful in 96% of cases.

Conclusion

EnDCR is a safe procedure with good success rate and has potential advantages in chronic dacryocystitis cases. The use of silicon intubation in nasolacrimal pathway helps in maintaining the patency of rhinostomy.     

Endonasal endoscopic dacryocystorhinostomy: our experience

Objectives

To study the outcome of endonasal endoscopic dacryocystorhinostomy (DCR) with or without mucosal flap preservation, without mitomycin local application, silicon tube stenting or laser assistance. To determine the duration of the surgical procedure of DCR, influence of simultaneously performed endonasal endoscopic procedures for concomitant sinonasal diseases.

Methods

Combined retrospective and prospective study in our tertiary referral center. 24 patients with chronic dacryocystitis underwent 25 standard endonasal endoscopic DCR procedures, 10 with and 15 without mucosal flap preservation. 6 of these had concomitant sinonasal diseases for which they underwent septoplasty or functional endoscopic sinus surgery (FESS) or both, simultaneously or as staged procedures. Relief from epiphora and patency of the nasolacrimal fistula was assessed by nasal endoscopy and syringing of the lacrimal apparatus at 1 week, 3 weeks and 3 months postoperatively.

Results

Out of 18 patients who underwent only DCR, 17 patients (94.44%) had complete relief from epiphora. Out of 6 patients who underwent 7 DCRs with concomitant sinonasal surgery, 5 patients (85.71%) had complete relief from epiphora. Overall 23 out of 25 DCRs (92%) had complete relief. In 15 of the 25 procedures, mucosal flap was excised completely. In remaining 10 procedures, flap was trimmed, repositioned to cover exposed bone around the newly created nasolacrimal fistula. In either situation, only one patient each had partial block of the nasolacrimal fistula. Average duration of the surgical procedure of DCR was 18 min.

Conclusion

Endonasal endoscopic DCR is a viable alternative to external DCR, co-existing sinonasal diseases can be managed simultaneously, as may be required in 25% of cases. It can be performed under 20 min without mucosal flap preservation, mitomycin local application, silicon tube stenting or laser assistance and can still provide a good success rate (92%) with less complications.     

Endoscopic dacryocystorhinostomy with conventional instruments: results and advantages over external dacryocystorhinostomy

Background

The aim of study is to evaluate the Endoscopic dacryocystorhinostomy (DCR) with conventional instruments, its results and advantage over external dacryocystorhinostomy (DCR).

Methods

The study group comprised of 127 patients who underwent consecutive endoscopic dacryocystorhinostomy. The cases operated by one team were included in the study to make the uniform analysis and its result. There were 48 males and 79 female in this study and male female ratio was 1:1.6. The mean age of the patient was 37 years (range from 16 years to 58 years). There were wide variety of cases like epiphora, lacrimal sac abscess, lacrimal sac fistula, acute dacryocystitis and road vehicular accident. All the patients had undergone non-laser, non-powered conventional instruments surgery under local anesthesia. The lighted probe was not used in any case for sac identification. The free flow of saline through newly created stoma during sac syringing was considered as successful criteria. The stent was used in two cases of road vehicular accident and in remaining 125 cases no stent was used. There were 66 cases of epiphora, 30 cases of lacrimal sac abscess, 26 cases of acute dacryocystitis, 3 cases of lacrimal fistula and 2 case of road traffic accident with multiple fractures. The average follow up period was 17 months (maximum follow up 3 years and minimum 4 months.)

Results

The success rate was 96 %.

Conclusion

The endoscopic DCR with conventional instruments is safe with very high success rate without any complications. It can be done in acute cases and very much suited for lacrimal sac abscess and lacrimal sac fistula.     

Treatment of basal-cell carcinomas with a carbon-dioxide laser.

Treatment of basal-cell carcinomas with a carbon-dioxide laser was studied in 24 lesions for adequacy of treatment, the healing process, and the eventual cosmetic result after twelve months. There was a recurrence rate of 50% at the end of one year; healing occurred with mild degrees of hypopigmentation, erythema, and depression; and the cosmetic result was rated good or better than good in 10 of 11 lesions available for judgment. The high recurrence rate was due, we think, to our cautious use of the laser, which, we think nevertheless, warrants further trial with more aggressive application.     

Endoscopic KTP-532 laser assisted diverticulotomy for Zenker's diverticulum

Zenker's diverticulum, though counnon in western countries is uncommon in India. This diverticuham is an extension of umcosa through Killian's dehiscence. Various surgical methods have been described for the treatment of this condition including the use of lasers but none in Indian Journals. In this paper we describe a case of Zenker's diverticulum where diverticulotomy using KTP532 laser was successfully performed. Its advantages over other techniques are mentioned.     

CT模拟定位系统外激光中心准确性的质量保证

目的 研究CT模拟定位系统外激光中心准确性的质量保证（BBQA）的摆位、扫描、操作技术及其在CT模拟定位系统质量保证中的作用。方法 Vertical column、BB、Jig、飞利浦PQS—Falcon型CT扫描机及ACQSIM工作站、激光定位系统。扫描BB并将其图像传输到ACQSIM工作站处理，得到等中心坐标后，移动外部激光系统，定位并检测。结果 外激光中心应正好在BB上，如果有超过1mm的误差，则应调整激光定位系统。结论 BBQA在CT模拟定位系统质量保证中占十分重要地位，直接影响到定位的精确度和治疗的准确性及治疗效果。     

MALDI-TOF质谱技术在肺癌中的应用

基质辅助激光解析电离飞行时间质谱（MALDI-TOF-MS）是一种新型的质谱技术,具有高通量、快速、重复性好、灵敏性高等优点,是目前肺癌研究与临床应用的重要工具,在肺癌早期诊断、筛查、疗效评价等方面有着良好的应用前景.     

A 7-year prospective study of routine histopathological evaluation of the lacrimal sac wall incisional biopsy specimens obtained during external dacryocystorhinostomy in adults and a review of the literature

The most common lacrimal sac pathology is chronic inflammation with or without occlusive fibrosis. However, a substantial number of lacrimal sac-specific pathologies were reported throughout the literature which may mimic chronic inflammation and be misdiagnosed. From a tertiary ophthalmic care centre in Serbia, in a single ophthalmic pathology laboratory, during a 7-year period (January 2004 to October 2010), a 599 consecutive lacrimal sac wall biopsy samples routinely obtained during external dacryocystorhinostomy in adult patients with clinically presumed primary acquired lacrimal drainage system obstruction were analysed. Although non-specific lacrimal sac pathology was present in the vast majority of cases (578 biopsy specimens; 96.49%), this report also reveals a relatively substantial number (21 biopsy specimens; 3.51%) of clinically non-suspected or intraoperatively unexpected primary lacrimal sac-specific pathology—among them, six lesions with malignant biological behaviour were identified: one microinvasive squamous cell carcinoma and five malignant lymhoproliferative lesions. Usefulness of routine lacrimal sac wall biopsy during surgery for primary acquired lacrimal drainage system obstruction is undoubtful and commensurate with the constant need for better understanding of the pathological processes that involve lacrimal drainage system.     

双向凝胶电泳飞行时间质谱技术筛选食管癌相关蛋白

目的：建立分辨率高和重复性好的人食管癌组织及其癌旁正常上皮组织的双向凝胶电泳分析方法,并筛选食管癌相关蛋白质。方法：选取10例食管癌及其癌旁正常上皮组织,提取总蛋白质进行双向凝胶电泳分析,并采用Blue silver法染色。凝胶图像分析后,对差异蛋白质进行MALDI-TOF质谱分析。结果：在所鉴定的6个差异蛋白质在中,磷酸丙糖异构酶1、锰超氧化物歧化酶和热休克蛋白27在食管癌组织中表达上调,而鳞状细胞癌抗原1、细胞角蛋白4和膜联蛋白Ⅰ在食管癌中表达下调。结论：所鉴定的这些差异蛋白将为阐明食管癌发生机制提供线索,也为寻找食管癌潜在标志奠定理论基础。     

Oral brush biopsy analysis by matrix assisted laser desorption/ionisation-time of flight mass spectrometry profiling--a pilot study

Oral squamous cell carcinomas (OSCCs) often present as advanced tumours requiring aggressive local and regional therapy and result in significant functional impairment. The objective is to develop pre-symptomatic screening detection of OSCC by a brush biopsy method which is less invasive than the conventional biopsy for histology. Given the molecular heterogeneity of oral cancer, it is unlikely that even a panel of tumour markers would provide accurate diagnosis. Therefore, approaches such as the matrix-assisted-laser-desorption/ionisation-time-of-flight-mass-spectrometry (MALDI-TOF-MS) allow several biomarkers or peptide profile patterns to be simultaneously assessed. Brush biopsies from 27 patients with histology-proven OSCCs plus 40 biopsies from 10 healthy controls were collected. MALDI-TOF-MS profiling was performed and additional statistical analysis of the data was used to classify the disease status according to the biological behaviour of the lesion. For classification a support vector machine algorithm was trained using spectra of brush biopsy samples to distinguish healthy control patients from patients with histology-proven OSCC. MALDI-TOF-MS was able to distinguish between healthy patients and OSCC patients with a sensitivity of 100% and specificity of 93%. In summary, MALDI-TOF-MS in combination with sophisticated bioinformatic methods can distinguish OSCC patients from non-cancer controls with excellent sensitivity and specificity. Further improvement and validation of this approach is necessary to determine its feasibility to assist the pre-symptomatic detection of head and neck cancer screening in routine daily practice.     

窄谱光成像（NBI）辅助钬激光治疗非肌层浸润膀胱尿路上皮癌的临床应用价值

目的:探究窄谱光成像（narrow band imaging,NBI）辅助钬激光治疗非肌层浸润膀胱尿路上皮癌（non-muscle invasive bladder cancer,NMIBC）的临床应用价值。方法:选取2014年2月至2016年2月本院收治的NMIBC患者82例为研究对象。按照简单随机分组方法将患者分为两组,研究组（n=41）患者行NBI辅助钬激光治疗,对照组（n=41）患者行普通白光成像（white light imaging,WLI）辅助钬激光治疗。观察两组手术时间、并发症（闭孔神经反射、膀胱穿孔）发生率、首次随访（术后3个月）肿瘤残留率;术后3个月、6个月、12个月肿瘤复发率;肿瘤原位及异位复发情况。结果:研究组手术时间短于对照组,并发症中闭孔神经反射发生率低于对照组,首次随访肿瘤残留率亦低于对照组,差异均有统计学意义（P<0.05）。研究组患者术后3个月、6个月、12个月复发率均低于对照组;术后总复发率研究组为9.76%,明显低于对照组的31.71%,差异有统计学意义（P<0.05）。研究组患者肿瘤原位复发率（2.44%）明显低于对照组（19.51%）(P<0.05);而肿瘤异位复发率于两组间比较无统计学差异（P>0.05）。结论:NBI辅助钬激光治疗NMIBC操作简便,可缩短手术时间,且安全性高,疗效确切,能够显著降低NMIBC患者肿瘤残留率及复发率、原位复发率,颇具临床应用价值,可作为NMIBC的理想治疗方式。     

MALDI-TOF-MS检测人群中骨形成蛋白4基因编码区突变方法的建立

目的：应用基质辅助激光解吸电离-飞行时间质谱（MALDI-TOF-MS）技术建立检测人群中骨形成蛋白4（BMP4）基因编码区突变的平台。方法：采用PCR扩增BMP4基因,产物纯化后利用MALDI-TOF-MS技术对广东籍100例非综合征型唇腭裂患儿及91例健康对照者外周血进行BMP4基因突变的检测并进行测序验证。结果：采用MALDI-TOF-MS平台检测的191份样本均未发现BMP4基因编码区存在T102A、R162Q及R198X突变,与测序结果一致。结论：成功建立基于MALDI-TOF-MS检测BMP4基因编码区突变的平台,该方法具有高通量、快速、准确的特点。     

Performance of matrix‐assisted laser desorption‐time of flight mass spectrometry for identification of clinical yeast isolates

Accurate and fast yeast identification is important when treating patients with invasive fungal disease as susceptibility to antifungal agents is highly species related. Matrix‐assisted laser desorption‐time of flight mass spectrometry (MALDI‐TOF‐MS) provides a powerful tool with a clear potential to improve current diagnostic practice. Two MALDI‐TOF‐MS‐systems (BioTyper/Bruker and Saramis/AXIMA) were evaluated using: (i) A collection of 102 archived, well characterised yeast isolates representing 14 different species and (ii) Prospectively collected isolates obtained from clinical samples at two participating laboratories. Of the 102 archived isolates, 81 (79%) and 92 (90%) were correctly identified by Saramis/AXIMA and BioTyper/Bruker respectively. Saramis/AXIMA was unable to separate Candida albicans, C. africana and C. dubliniensis in 13 of 32 isolates. After manual interpretation of the mass spectra output, all 13 isolates were correctly identified, resulting in an overall identification performance of 92%. No misidentifications occurred with the two systems. Of the routine isolates one laboratory identified 99/99 (100%) and 90/99 (91%) to species level by Saramis/Axima and conventional identification, respectively, whereas the other laboratory identified 83/98 (85%) to species level by both BioTyper/Bruker and conventional identification. Both MALDI‐TOF‐MS systems are fast, have built‐in databases that cover the majority of clinically relevant Candida species, and have an accuracy that outperforms our conventional identification systems.     

Identification and typing of the emerging pathogen Candida auris by matrix‐assisted laser desorption ionisation time of flight mass spectrometry

Candida auris is an emerging antifungal resistant yeast species causing nosocomial and invasive infections, emphasising the need of improved diagnostics and epidemiological typing methods. We show that MALDI‐TOF VITEK‐MS followed by amplified length polymorphisms allows for accurate species identification and subsequent epidemiological characterisation of strains encountered during potential outbreaks.     

Matrix‐assisted laser desorption/ionisation (MALDI) TOF analysis identifies serum angiotensin II concentrations as a strong predictor of all‐cause and breast cancer (BCa)‐specific mortality following breast surgery

MALDI‐TOF MS was used to recognise serum peptidome profiles predictive of mortality in women affected by early BCa. Mortality was analysed based on signal profiling, and appropriate statistics were used. The results indicate that four signals were increased in deceased patients compared with living patients. Three of the four signals were individually associated with all‐cause mortality, but only one having mass/charge ratio (m/z) 1,046.49 was associated with BCa‐specific mortality and was the only peak to maintain an independent prognostic role after multivariate analysis. Two groups exhibiting different mortality probabilities were identified after clustering patients based on the expression of the four peptides, but m/z 1,046.49 was exclusively expressed in the cluster exhibiting the worst mortality outcome, thus confirming the crucial value of this peptide. The specific role of this peak was confirmed by competing risk analysis. MS findings were validated by ELISA analysis after demonstrating that m/z 1,046.49 structurally corresponded to Angiotensin II (ATII). In fact, mortality results obtained after arbitrarily dividing patients according to an ATII serum value of 255 pg/ml (which corresponds to the 66^th percentile value) were approximately comparable to those previously demonstrated when the same patients were analysed according to the expression of signal m/z 1,046.49. Similarly, ATII levels were specifically correlated with BCa‐related deaths after competing risk analysis. In conclusion, ATII levels were increased in women who exhibited worse mortality outcomes, reinforcing the evidence that this peptide potentially significantly affects the natural history of early BCa. Our findings also confirm that MALDI‐TOF MS is an efficient screening tool to identify novel tumour markers and that MS findings can be rapidly validated through less complex techniques, such as ELISA.