KTP‐532 laser‐assisted endoscopic nasal sinus surgery

KTP‐532 laser‐assisted endoscopic nasal sinus surgery The present study is meant to give an overview of the application of KTP lasers in endoscopic sinus surgery and to give an account of the experience gained in the course of 24 operations. Laser‐assisted FESS was performed in 24 patients (13 on the right side and 11 on the left side). Sixteen men and eight women were treated for chronic maxillary sinusitis. Diagnostic criteria of chronic maxillary sinusitis included at least 3 months history of intermittent or persistent facial pain, intermittent or persistent fever, tenderness or headache over the areas of the maxillary, ethmoid or frontal sinuses, purulent discharge from nasal passages or nasopharynx, and radiographic evidence of opacification on CT scans. Traditional FESS surgery was performed on the one side and KTP laser‐assisted surgery on the other side. CT was performed in each case. The operations were carried out under local anaesthesia. The KTP laser was delivered via an optical fibre (0.6 mm) and was used for bone ablation, incision, vaporization and coagulation. Patient symptoms were recorded using a self‐administered questionnaire preoperatively, and postoperatively on weeks 1, 4, 12 and 24. Blood loss on the laser‐assisted operations' side was minimal. The improvement of the symptoms (pain, sensation of fullness, discharge) during weeks 1 and 4 proved to be significant (P < 0.05) in the case of both techniques. The cumulated average of the point scores on the laser‐assisted side was higher: especially postoperative week 1. Of the parameters assessed in the course of healing, oedema prevailed on the laser‐assisted side, while crusting was characteristic in the traditional operation site. We conclude that laser‐assisted FESS surgery is as effective as traditional endonasal sinus surgery. Its advantage is that it offers excellent haemostasis, as the use of ‘star pulse’ mode allows accurate bone work. No complications were observed. The disadvantage of the laser‐assisted procedure is that the instrument is expensive and it is time consuming.     

Analysis of Treatment Results for Floor‐of‐Mouth Cancer

Objective This study reports the results of treating floor‐of‐mouth cancer with five different treatment modalities with long‐term follow‐up. Study Design Retrospective study of 280 patients with floor‐of‐mouth cancer treated in the Department of Otolaryngology—Head and Neck Surgery at Washington University Medical School (St. Louis, MO) from 1960 to 1994. Methods Patients with biopsy‐proven squamous cell carcinoma of the floor of mouth who were previously untreated were treated with curative intent by one of five modalities and were all eligible for 5‐year follow‐up. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow‐up parameters were studied using standard statistical analysis to determine statistical significance. Results The overall 5‐year disease‐specific survival (DSS) was 56% with death due to tumor in 44% of patients. The 5‐year cumulative disease‐specific survival (CDSS) was 0.61 (Kaplan‐Meier probability) with a mean of 8.3 years and a median of 9.7 years. The DSS by treatment modality included local resection (76%), composite resection (63%), radiation therapy (43%), local resection with radiation therapy (61%), and composite resection with radiation therapy (55%). Overall, there was no significant difference in DSS by treatment modality. Recurrence at the primary site (41%) was the most common site of treatment failure. Nineteen percent of patients had recurrence in the neck. Eighty‐eight percent of initial recurrences occurred within 60 months after the onset of treatment. Metastasis to a distant site occurred in 30% of patients. Twenty percent of these patients had second primary cancers, and 53% of these patients died of their second primary cancers. Conclusions Significantly improved 5‐year DSS was seen in the patients with clear margins, early clinical tumor stage, and negative nodes. Significantly decreased 5‐year survival was seen in the patients with involved margins, advanced clinical tumor stage, positive nodes, and tumor recurrence. Patients with no clinically positive nodes (cN0) can be observed safely for regional nodal disease and subsequent positive nodes can be treated as they occur with no adverse affect on survival. Because of high recurrence rates at the primary site and neck, and an increased rate of both distant metastasis and the development of second primary cancers, patients should be monitored closely for a minimum of at least 5 years.     

Sudden deafness: long‐term follow‐up and recurrence

We examined the long‐term outcome for patients with idiopathic sudden sensorineural hearing loss (sudden deafness), including the incidence of recurrence of sudden deafness. The subjects were 1798 individuals who came to Nagoya University hospital within 2 weeks of the onset of unilateral sudden deafness. Only 14 of the patients had a history of being diagnosed with sudden deafness. After their visit to our hospital, one patient had a recurrence in the ipsilateral ear and four patients experienced sudden deafness in the contralateral ear. We performed hearing examinations on 88 patients who revisited our hospital more than 10 years after unilateral sudden deafness. Of these patients, there was one with a recurrence in the ipsilateral ear and one with sudden deafness in the contralateral ear. Thus, in this series the recurrence of sudden deafness was rare.     

Detection of paranasal ectopic adrenocorticotropic hormone‐secreting pituitary adenoma by Ga‐68‐DOTANOC positron‐emission tomography–computed tomography

Ectopic adrenocorticotropic hormone (ACTH)‐secreting tumors account for approximately 10% of Cushing's syndrome (CS). We present an extremely rare case of a patient with CS caused by an ectopic ACTH‐secreting pituitary adenoma (EAPA) of the ethmoid sinus. The tumor was identified by positron‐emission tomography–computed tomography (PET/CT) using the somatostatin receptor analogue Ga‐68‐DOTANOC. Transnasal endoscopic resection was performed and the patient showed significant clinical improvement with normalization of the endocrine pituitary axis. Immunostaining showed a somatostatin receptor 2 and 5‐positive ACTH‐producing adenoma. In patients with ectopic ACTH secretion, Ga‐68‐DOTANOC‐PET/CT may play an important role in the localization of EAPA. Transnasal endoscopic resection is the therapy of choice.     

HLA‐DRB1, ‐DQA1, and ‐DQB1 Genotypes in Patients With Nasal Polyposis

Objectives/Hypothesis Genetic etiology is suspected in the development of nasal polyposis on the basis of familial aggregation. This study investigated whether there is an association between HLA‐DRB1, ‐DQA1, and ‐DQB1 alleles and developing nasal polyposis. Study Design Data from 50 polypectomized patients were compared with data from 50 healthy randomly selected controls. Polyp score, possible asthma, aspirin sensitivity, and ASA triad were also recorded. Methods Genotyping of HLA‐DRB1 alleles was carried out with the Dynal RELI SSO HLA‐DRB, a direct DNA probe test that utilizes a polymerase chain reaction (PCR) and nucleic acid hybridization for the differentiation of 70 HLA‐DRB alleles and 9 supertypes. For DQA1* genotyping PCR‐RFLP (restriction fragment length polymorphism) was used, differentiating eight alleles. The DQB1* typing was carried out using a INNO‐LiPA DQB PCR‐reverse hybridization kit, allowing the discrimination of 30 alleles. Results People carrying the HLA‐DR7‐DQA1*0201, and ‐DQB1*0202 haplotype were found to have a two to three times higher odds ratios (ORs) for developing the disease, compared with controls. Patients with ASA triad carried the above‐mentioned DR7 allele with the linked alleles significantly more often (P < .001). Subjects carrying HLA‐DR5 allele and the linked alleles had lower odds ratio values. Conclusion These results underline that allergy is not conditional for the formation of nasal polyps as thought before. Nasal polyposis associated with asthma and aspirin sensitivity is probably a unique form of nasal polyps. The authors plan further investigations in this field.