Hyaluronan in the Treatment of Chronic Rhinosinusitis with Nasal Polyposis

Chronic rhinosinusitis (CRS) is a common condition and affects the quality of life of approximately 16 % of adults in US and 10.9 % in Europe. Hyaluronan (HA) is a nonsulphate glycosaminoglycan found in the extracellular matrix of connective tissues, and plays an important role in the healing process and repair of mucosal surfaces. We aim to evaluate the effect of HA on nasal symptoms and endoscopic appearance in patients with CRS and nasal polyps (NP) who have not undergone sinus surgery. Eighty patients older than 18 years old were randomized to receive either open-label nebulized saline solution (NS) or intranasal corticosteroid spray (ICS) 200 µg bid or nebulized sodium hyaluronate (NHA, YABRO^®) or both ICS and NHA. Results were collected at 1 month, 3 months and 3 months after treatment. Significant improvements in nasal symptoms scores, endoscopic appearance scores, radiologic scores, rhinomanometry and saccharine clearance test were observed in the NHA, ICS and ICS + NHA groups after 1 month and 3 months of treatment compared with baseline (all p ≤ 0.005). The use of oral steroids was significantly reduced after 3 months of therapy in the same groups versus baseline (all p < 0.05). The incidence of adverse events at 3 months was similar between the 4 groups (all p > 0.05). Throat irritation, nasal burning and drug-related epistaxis were not reported in the group NHA. HA, as a nebulized nasal douche preparation, improved nasal symptoms and endoscopic appearances in patients with CRS and NP who have not undergone sinus surgery.     

Endoscopic Sinus Surgery in Chronic Rhinosinusitis and Nasal Polyposis: A Comparative Study

Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12 months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1 year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1 year follow up in the nasal polyp group.     

Correlation of Nasal Nitric Oxide Measurement with Computed Tomography Findings in Chronic Rhinosinusitis

Nitric oxide (NO) is a biological messenger produced by mammalian cells serving various functions including regulation of blood flow, platelet function, immunity, and neurotransmission. The paranasal sinuses and nasal mucosa are a major source of exhaled NO. The aim of the study is to compare the nasal NO (nNO) levels in patients with chronic rhinosinusitis with those of common cold patients and controls and to correlate CT scores with nNO levels. The nasal concentration of NO was measured by electroluminescence in 13 healthy volunteers, in 13 patients suffering from common cold and 13 patients with chronic rhinosinusitis. The concentration of NO was correlated with symptom scores, endoscopic findings and CT findings. The measured levels of NO did not differ between healthy volunteers and common cold patients, but they were significantly lower in patients suffering from chronic rhinosinusitis. As NO is a regulator of mucociliary activity and has bacteriostatic and antiviral effects, the decreased concentration of nNO in patients suffering from sinusitis suggests that lack of NO may contribute to the pathogenesis of this disease. Thus, nNO, which is easily measured, provides a valuable non-invasive objective measure of chronic rhinosinusitis.     

术后放射治疗对非小细胞肺癌疗效的影响

目的：探讨术后放射治疗对非小细胞肺癌疗效的影响。方法：1989年1月至1993年12月，在本院接受手术治疗的非小细胞肺癌患者中有189例无肉眼和镜下残留。病理分期为T1-3、N1-2、M0，其中75例接受术后放射治疗(综合组)，114例单纯手术治疗(手术组)。综合组于术后22～53天开始照射患侧肺门和纵隔，剂量为46-66Gy／23～33次／5-7周(中位数56Gy)。用寿命表及Log-Rank法计算和比较两组病例的生存率与局控率。结果：两组病例的年龄、性别、病理类型、临床分期和手术方式等基本相同。综合组1、3、5年生存率分别为82．7％、40．0％、2913％；手术组分别为7613％、39．5％、28、1％，两组比较差异无显著意义(X^2=0.25，P=0.6233)。综合组1、3、5年局控率分别为95、7％、78．5％、68、5％，明显高于手术组的81．0％、58．3％、55．1％(X^2=4．4961，P=0.03691)。综合组出现胸内复发的中位时间为22、5个月(747个月)，手术组为12.0个月(4～60个月)，两组比较差异有显著意义(X^2=4.103，P=4.043)。结论：术后放射治疗能提高有肺门或纵隔淋巴结转移Ⅱ、Ⅲa期非小细胞肺癌的局控率，延长复发出现的时间，但未能改善其生存率。     

家族性腺瘤性息肉病的外科治疗

家族性腺瘤性息肉病（family adenomatous polyposis,FAP）属常染色体显性遗传疾病,目前被认为是癌前病变,而且癌变往往为多发性、多中心性。我们收集了28例FAP患者的临床资料,就FAP的临床特点和外科治疗进行探讨。     

Versatility of Pectoralis Major Myocutaneous Flap in Oncosurgery and Its Role in Developing Countries

Schwannoma of nasal septum presentation is exceedingly rare in the literature, previously reported multiple lesions involving the paranasal sinuses or nasal mucosa. We report the case of a 20 year-old yellow male with a tiny schwannoma arising from the nasal septum, complaining of lightly alternate nasal obstruction. Both anterior and endo-rhinoscopy didn’t detect this tiny smooth-surfaced mass and other abnormality, except a little septal deviation. After final clinical diagnosis, we completely removed this tumor and corrected the deviation by an endoscopic approach. We discuss the clinical presentation, differential diagnosis, pathologic diagnosis factor and therapy of this rarely encountered neoplasm.     

鼻中隔涎腺腺泡细胞癌1例

涎腺腺泡细胞癌是一种临床上少见的低度恶性肿瘤,多发生于腮腺、颌下腺、舌下腺及小唾液腺等涎腺。发生于鼻中隔的极为罕见,本文报道一例近期发现的位于鼻中隔的涎腺腺泡细胞癌。     

Comparing the Efficacy of Alkaline Nasal Douches Versus Decongestant Nasal Drops in Postoperative Care After Septal Surgery: A Randomised Single Blinded Clinical Pilot Study

To compare the efficacy of alkaline nasal douches and decongestant nasal drops following nasal septal surgery. This was a prospective, randomised, single-blind pilot study. Twenty patients were included in each arm of the study undergoing elective nasal septal surgery. The primary outcome measure was nasal congestion. Secondary outcome measures were anosmia, facial pain, nasal discharge, and sneezing/itching. This study does not show any statistically significant difference between the two treatment groups. Symptoms of nasal congestion (P = 0.3), facial pain (P = 0.932), nasal discharge (P = 0.98), sneezing (P = 0.59) and anosmia (P = 0.208) were analysed before conclusion. Three patients in saline group and one patient in the nasal drops group had poor compliance to follow the advice, scoring 2 on a VAS score but the treatment was tolerated well in majority of the patients. No statistical significant differences were noted on analysing the post operative complications in either group. In this study, both nasal douches and decongestant nasal drop were well tolerated. Both treatments provided good postoperative relief from nasal congestion, nasal discharge, sneezing, facial pain and anosmia as days progressed. The post operative examination of the nose among these patients revealed no significant complications in either of the study arm.     

Endoscopic Transseptal Approach to Frontal Sinus Disease

This paper describes an endoscopic transseptal approach to identify and access the frontal sinus and reviews the clinical cases. Between May 2004 and July 2010, endoscopic modified Lothrop procedure (EMLP) with transseptal approach was performed on sixteen patients. The indications for EMLP were complicated frontal sinusitis or cyst, revision surgery for failed frontal sinusotomy or Lynch procedure, or trauma cases. The first step of this procedure was to open a window in the bilateral anterior portion of the middle turbinates and nasal septum. The nasal septum, which could be observed through the window, should be the landmark of the midline during the surgery. A drill bur was raised up just behind the nasal bone along the midline of the nose. After the bilateral frontal sinuses and their posterior walls were confirmed, the interfrontal septum was removed superiorly. We reviewed the clinical records of patients who underwent the EMLP with transseptal approach. We have managed sixteen patients in this fashion. Neither intracranial nor orbital complications were encountered during or after surgery. Endoscopic transseptal frontal sinus surgery is simple to perform, and does not cause severe complications.     

子宫内膜癌预后因素分析

 目的　探讨子宫内膜癌的预后因素。方法　观察 2 4 7例手术治疗的子宫内膜癌患者的生存率。结果　总 5年生存率 74.9% , 、 、 、 期患者的 5年生存率为 88.5%、84.1 %、45.9%和 36.4%。IA、IB期低 ,高危患者的 5年生存率为 92 .6%和 2 /2、93.5%和 73.3%。结论　分期和淋巴结转移是影响子宫内膜癌预后的主要因素。低危 期内膜癌单纯手术疗效良好。放疗可改善高危 期内膜癌的预后、而对 、 、 期内膜癌预后的影响尚不能肯定.     

减少并发症的宫颈癌根治手术方法探索

[目的]探索降低宫颈癌根治术后尿潴留、尿瘘及泌尿道感染等并发症发生率的手术方式。[方法]对50例早期宫颈癌病例,在实施根治术的同时作输尿管悬吊、部分阴道重建和膀味造瘘术。（结果）与文献报道相比,上述方法能显著降低术后尿疾及泌尿道感染发生率,并能有效延长阴道长度和缩短住院时间。（结论）上述方法是降低宫颈癌术后并发症的有效措施,具有良好的临床应用前景。     

Hereditary neoplasia syndromes and the role of the surgeon

The complex and often variable clinical presentations of patients with hereditary neoplasia syndromes mandates a multidisciplinary approach to management. The involvement of surgeons in the assessment and management of these patients is essential, in that the majority of patients affected with hereditary neoplasms will, at some point, require resection of the target organs affected by specific gene mutations, with prophylactic or therapeutic intent, or both. As the pathogenesis of the known hereditary neoplasia syndromes becomes better understood at the molecular level, innovative targeted therapies will, inevitably, supplant or replace surgery as the primary treatment modality for these diseases. Until that time, however, surgeons will continue to play a prominent role in the care of patients with hereditary neoplasia syndromes. As is already occurring within many other clinical specialties, the incorporation of at least a basic understanding of the genetic mechanisms of disease transmission and expression are essential within the surgical specialties, as the two cases presented herein demonstrate. In this paper, we present two cases that illustrate many of the challenges inherent in the surgical management of patients with hereditary neoplasia syndromes: a patient with attenuated familial adenomatous polyposis syndrome, and a patient with multiple endocrine neoplasia syndrome, type 2–B.     

抗纤方中药制剂防治肺辐射损伤的临床研究

 目的 探讨抗纤方中药制剂对胸部肿瘤放疗所致肺辐射损伤的预防作用。方法 148例胸部肿瘤患者随机分为实验组70例，对照组78例；均接受胸部肿瘤常规放疗；实验组病例在放疗同时应用抗纤方中药制剂治疗至放疗结束；对照组患者则接受安慰剂治疗。结果 两组放疗后放射性肺炎及放射性肺纤维化的发生率分别为38.4 %，12.8 %和29.4 %，8.5 %，两组比较差异有统计学意义（P＜0.05）。结论 抗纤方中药制剂能够降低胸部肿瘤放疗所致放射性肺炎及肺纤维化的发生率，对肺辐射损伤有明显的预防作用。     

Postoperative adjuvant therapy for completely resected early-stage non-small cell lung cancer

Consensus on adjuvant therapy for completely resected non-small cell lung cancer until 2002 was as follows. (1) There was no significant impact of postoperative adjuvant chemotherapy based on meta-analysis and previous clinical trials. (2) Confirmatory studies are necessary in large-scale prospective clinical trials. However, recent mega trials have introduced epoch-making changes for postoperative adjuvant chemotherapy in clinical practice since ASCO 2003. The effectiveness of UFT in N0 patients was confirmed. Patients with completely resected stage I non-small cell lung cancer, especially T2N0 adenocarcinoma, will benefit from adjuvant chemotherapy with UFT. The results of the International Adjuvant Lung Trial (IALT) have confirmed the meta-analysis in 1995. Also, both the JBR10 and Cancer and Leukemia Group B (CALGB) 9633 studies have also confirmed positive IALT results of the benefit for postoperative platinum-based chemotherapy in completely resected non-small cell lung cancer. Adjuvant chemotherapy for pathological stage IB to II, completely resected non-small cell lung cancer is standard care based on clinical trials. UFT showed the strongest evidence for IB in Japan. Platinum doublet chemotherapy with third-generation anticancer agents is also recommended. Adjuvant chemotherapy should be offered as standard care to patients after completely resected early stage non-small cell lung cancer. However, there is no evidence of the feasibility and efficacy for adjuvant chemotherapy with the platinum-based regimen in Japan. Careful management should be necessary in such treatment.The ASCO-JSCO Joint Symposium was held in Kyoto, Japan, on October 29, 2004.     

阑尾杯状细胞类癌3例临床病理分析

目的探讨阑尾杯状细胞类癌的临床病理特点及免疫表型。方法对3例阑尾杯状细胞类癌进行组织学观察及免疫组化分析,并分析其临床资料。结果 3例阑尾杯状细胞类癌均为男性,平均年龄54岁,临床表现均为右下腹痛,术前均诊断为急性阑尾炎,肿瘤均位于阑尾尖部,平均直径为8.5 mm,组织学上由形态一致的杯状细胞形成巢状结构,呈浸润性生长,3例均侵及阑尾浆膜层。免疫表型：Syn及CgA均呈阳性,CK、NSE为局灶性阳性,CEA均为弥漫性阳性。随访至2010年6月均为无瘤生存。结论阑尾杯状细胞类癌是1种组织形态和免疫表型上具有外分泌和内分泌双重特点的肿瘤,较经典类癌更具侵袭性,需与腺癌鉴别。     

术前病理学诊断在胸腺肿瘤诊疗中的应用

背景与目的探讨术前病理学诊断在胸腺肿瘤诊断和治疗中的价值及其对胸腺肿瘤治疗的影响。方法对中国胸腺肿瘤协作组（Chinese Alliance for Research in hTymomas, ChART）收集的1994年-2012年的多中心且具有明确活检状态的胸腺肿瘤患者的临床病理资料进行回顾性分析,探讨术前病理学诊断的应用趋势及其对胸腺肿瘤患者预后的影响。结果1,902例胸腺肿瘤患者中,术前病理学诊断患者336例（17.1%）。近年来术前病理学诊断的比例较前明显增加（P=0.008）,胸腔镜/纵隔镜/超声内镜下经支气管活检（endobronchial ultrasound, E-BUS）比例较前升高（P=0.029）。术前行病理学诊断患者的生存明显差于无病理学诊断患者（P<0.001）,术前病理学诊断后的目的与肿瘤的Masaoka分期（P<0.001）、切除程度（P=0.025）、病理类型（P<0.001）具有相关性。术前病理学诊断后直接手术患者的生存要明显优于诱导治疗后再手术患者（P<0.001）。结论胸腺瘤诊断主要依靠临床及组织学判断,近年来术前病理学诊断在胸腺肿瘤的诊断和治疗中起重要作用;根治性手术切除是胸腺肿瘤的首先治疗手段;术前病理学诊断后直接手术患者的预后要明显优于诱导治疗后患者。     

Rhinocerebral mucormycosis: A deadly disease on the rise

According to WHO, there will be epidemic of diabetes world over and India is going to be ‘A diabetes capital of the world’ by 2025. With the increasing incidence of diabetes, the associated complications are also bound to increase. Rhinocerebral mucormycosis is one of them. Rhinocerebral Mucormycosis is an opportunistic, fulminating fungal infection, caused by Rhizopus species of order of mucorales, frequently seen in diabetic and immunocompromised patients. Mucormycosis has a very high mortality rate. Early diagnosis and treatment with Amphotericin-B is the key to combat this disease successfully. We have seen 13 cases in last 3 years (2002–2005) in our area. This incidence is significant, as this type of cases were rarely seen before 2002, in this geographical area. We present an account of these cases; treatment strategies adopted, review of literature, and highlight ‘the role of ENT surgeon in diagnosis and management of this dreadful disease’.     

Interventional Ductoscopy as an Alternative for Major Duct Excision or Microdochectomy in Women Suffering Pathologic Nipple Discharge: A Single-center Experience

IntroductionPathologic nipple discharge (PND) is, after palpable lumps and pain, the most common breast-related reason for referral to the breast surgeon and is associated with breast cancer. However, with negative mammography and ultrasound, the chance of PND being caused by malignancy is between 5% and 8%. Nevertheless, most patients with PND still undergo surgery in order to rule out malignancy. Ductoscopy is a minimally invasive endoscopic technique that enables direct intraductal visualization. The aim of this study was to evaluate (interventional) ductoscopy as an alternative to surgery in patients with negative conventional imaging.Materials and MethodsAll patients with PND referred between 2010 and 2017 to our hospital for ductoscopy were retrospectively analyzed. Ductoscopy procedures were performed under local anesthesia in the outpatient clinic. The follow-up period was at least 3 months, and the primary outcome was the number of prevented surgical procedures. Furthermore, we evaluated possible complications after ductoscopy (infection and pain).ResultsA total of 215 consecutive patients undergoing ductoscopy were analyzed. In 151 (70.2%) patients, ductoscopy was successful. In 102 procedures, an underlying cause for PND was visualized, of which 34 patients could be histologically proven and 82 patients treated. Sixty of the 215 patients were eventually operated, 8 owing to suspicious findings during ductoscopy, 42 owing to persistent PND, and 10 because of recurrent PND. In 7 patients, a malignancy was found (5 of them classified as suspicious at dusctoscopy). No serious side effects were seen.ConclusionDuctoscopy can be safely used as an alternative for surgery in the workup for PND.     

Sarcopenia in Resected NSCLC: Effect on Postoperative Outcomes

Introduction

Skeletal muscle depletion, referred to as sarcopenia, has recently been identified as a risk factor for poor outcomes in various malignancies. However, the prognostic significance of sarcopenia in patients with NSCLC after surgery has not been adequately determined. This study investigated the impact of sarcopenia in patients undergoing pulmonary resection for lung cancer.