bluuebunny/crossref_metadata_2025 huggingface dataset:
Voltage-Gated Ion Channels in Human Pancreatic β-Cells: Electrophysiological Characterization and Role in Insulin Secretion
Authors: Braun Matthias , Ramracheya Reshma , Bengtsson Martin , Zhang Quan , Karanauskaite Jovita , Partridge Chris , Johnson Paul R. , Rorsman Patrik
Published: April 2008

OBJECTIVE— To characterize the voltage-gated ion channels in human β-cells from nondiabetic donors and their role in glucose-stimulated insulin release.

RESEARCH DESIGN AND METHODS— Insulin release was measured from intact islets. Whole-cell patch-clamp experiments and measurements of cell capacitance were performed on isolated β-cells. The ion channel complement was determined by quantitative PCR.

RESULTS— Human β-cells express two types of voltage-gated K+ currents that flow through delayed rectifying (KV2.1/2.2) and large-conductance Ca2+-activated K+ (BK) channels. Blockade of BK channels (using iberiotoxin) increased action potential amplitude and enhanced insulin secretion by 70%, whereas inhibition of KV2.1/2.2 (with stromatoxin) was without stimulatory effect on electrical activity and secretion. Voltage-gated tetrodotoxin (TTX)-sensitive Na+ currents (NaV1.6/1.7) contribute to the upstroke of action potentials. Inhibition of Na+ currents with TTX reduced glucose-stimulated (6–20 mmol/l) insulin secretion by 55–70%. Human β-cells are equipped with L- (CaV1.3), P/Q- (CaV2.1), and T- (CaV3.2), but not N- or R-type Ca2+ channels. Blockade of L-type channels abolished glucose-stimulated insulin release, while inhibition of T- and P/Q-type Ca2+ channels reduced glucose-induced (6 mmol/l) secretion by 60–70%. Membrane potential recordings suggest that L- and T-type Ca2+ channels participate in action potential generation. Blockade of P/Q-type Ca2+ channels suppressed exocytosis (measured as an increase in cell capacitance) by >80%, whereas inhibition of L-type Ca2+ channels only had a minor effect.

CONCLUSIONS— Voltage-gated T-type and L-type Ca2+ channels as well as Na+ channels participate in glucose-stimulated electrical activity and insulin secretion. Ca2+-activated BK channels are required for rapid membrane repolarization. Exocytosis of insulin-containing granules is principally triggered by Ca2+ influx through P/Q-type Ca2+ channels.
Serum Heat Shock Protein 27 and Diabetes Complications in the EURODIAB Prospective Complications Study
Authors: Gruden Gabriella , Bruno Graziella , Chaturvedi Nish , Burt Davina , Schalkwijk Casper , Pinach Silvia , Stehouwer Coen D. , Witte Daniel R. , Fuller John H. , Perin Paolo Cavallo ,   the EURODIAB Prospective Complications Study Group
Published: April 2008

OBJECTIVE—Heat shock protein 27 (HSP27) is a member of the small heat shock protein family of proteins. HSP27 expression is enhanced in target tissues of diabetic microvascular complications, and changes in circulating serum HSP27 levels (sHSP27) have been reported in patients with macrovascular disease. We investigated whether sHSP27 levels were associated with micro- and macrovascular complications in type 1 diabetic patients.

RESEARCH DESIGN AND METHODS—A cross-sectional, nested, case-control study from the EURODIAB Prospective Complications Study of 531 type 1 diabetic patients was performed. Case subjects (n = 363) were defined as those with one or more complications of diabetes; control subjects (n = 168) were defined as those with no evidence of any complication. We measured sHSP27 levels and investigated their associations with diabetes complications.

RESULTS—Mean sHSP27 levels were significantly higher in case subjects with distal symmetrical polyneuropathy (DSP) than in control subjects, even after adjustment for age and albumin excretion rate (AER) (785.9 vs. 574.7 pg/ml, P = 0.03). In logistic regression analysis, sHSP27 levels in the upper quartile were associated with a twofold increased odds ratio (OR) of DSP, independently of conventional risk factors, markers of inflammation, and AER (OR 2.41 [95% CI 1.11–5.24]).

CONCLUSIONS—In this large cohort of type 1 diabetic subjects, we found an independent association between sHSP27 and DSP. This suggests that sHSP27 levels may be a novel marker for diabetic neuropathy.
Novel De Novo Mutation in Sulfonylurea Receptor 1 Presenting as Hyperinsulinism in Infancy Followed by Overt Diabetes in Early Adolescence
Authors: Abdulhadi-Atwan Maha , Bushman Jeremy D. , Tornovsky-Babaey Sharona , Perry Avital , Abu-Libdeh Abdulsalam , Glaser Benjamin , Shyng Show-Ling , Zangen David H.
Published: April 2008

OBJECTIVE—Congenital hyperinsulinism, usually associated with severe neonatal hypoglycemia, may progress to diabetes, typically during the 4th decade of life in nonpancreatectomized patients. We aimed to genotype the ATP-sensitive K+ channel in a 10.5-year-old girl presenting with overt diabetes following hyperinsulinism in infancy.

RESEARCH DESIGN AND METHODS—A female aged 10.5 years presented with new-onset, antibody-negative diabetes (A1C 10.6%). She was born large for gestational age (5 kg) to a nondiabetic mother and developed frequent hypoglycemic episodes, which persisted until age 3 years and responded initially to intravenous glucose and later to oral sweets. Currently, she is fully pubertal and obese (BMI 30.2 kg/m2), with a partially controlled convulsive disorder (since age 1 year) and poor school performance. Glucose levels were >11.1 mmol/l throughout 72 h of continuous glucose monitoring, with low insulin secretion during intravenous glucose tolerance testing. KCNJ11 and ABCC8 mutation analysis was performed, and the mutation identified was characterized in COSm6 cells.

RESULTS—A novel, de novo heterozygous ABCC8 sulfonylurea receptor (SUR)1 mutation (R370S) was identified in the patient's DNA but not in that of either parent. Cotransfection of Kir6.2 and mutant SUR1 demonstrate that the mutated protein is expressed efficiently at the cell surface but fails to respond to MgADP, resulting in minimal channel activity. Interestingly, the heterozygous channel (WT:R370S) responded well to glibenclamide, a finding that lead to the successful initiation of sulfonylurea therapy.

CONCLUSIONS—This new ABCC8 mutation is associated with neonatal hyperinsulinism progressing within 10 years to insulinopenic diabetes. Consistent with in vitro findings, the patient responded to sulfonylurea treatment. The mechanism causing the relatively rapid loss in β-cell function is not clear, but it may involve mutation-induced increased β-cell apoptosis related to increased metabolic demand.
Effect of Oral Amino Acids on Counterregulatory Responses and Cognitive Function During Insulin-Induced Hypoglycemia in Nondiabetic and Type 1 Diabetic People
Authors: Rossetti Paolo , Porcellati Francesca , Busciantella Ricci Natalia , Candeloro Paola , Cioli Patrizia , Nair K. Sreekumaran , Santeusanio Fausto , Bolli Geremia B. , Fanelli Carmine G.
Published: April 2008

OBJECTIVE—Amino acids stimulate glucagon responses to hypoglycemia and may be utilized by the brain. The aim of this study was to assess the responses to hypoglycemia in nondiabetic and type 1 diabetic subjects after ingestion of an amino acid mixture.

RESEARCH DESIGN AND METHODS—Ten nondiabetic and 10 diabetic type 1 subjects were studied on three different occasions during intravenous insulin (2 mU · kg−1 · min−1) plus variable glucose for 160 min. In two studies, clamped hypoglycemia (47 mg/dl plasma glucose for 40 min) was induced and either oral placebo or an amino acid mixture (42 g) was given at 30 min. In the third study, amino acids were given, but euglycemia was maintained.

RESULTS—Plasma glucose and insulin were no different in the hypoglycemia studies with both placebo and amino acids (P > 0.2). After the amino acid mixture, plasma amino acid concentrations increased to levels observed after a mixed meal (2.4 ± 0.13 vs. placebo study 1.7 ± 0.1 mmol/l, P = 0.02). During clamped euglycemia, ingestion of amino acids resulted in transient increases in glucagon concentrations, which returned to basal by the end of the study. During clamped hypoglycemia, glucagon response was sustained and increased more in amino acid studies versus placebo in nondiabetic and diabetic subjects (P < 0.05), but other counter-regulatory hormones and total symptom score were not different. β-OH-butyrate was less suppressed after amino acids (200 ± 15 vs. 93 ± 9 μmol/l, P = 0.01). Among the cognitive tests administered, the following indicated less deterioration after amino acids than placebo: Trail-Making part B, PASAT (Paced Auditory Serial Addition Test) (2 s), digit span forward, Stroop colored words, and verbal memory tests for nondiabetic subjects; and Trail-Making part B, digit span backward, and Stroop color tests for diabetic subjects.

CONCLUSIONS—Oral amino acids improve cognitive function in response to hypoglycemia and enhance the response of glucagon in nondiabetic and diabetic subjects.
Silicone Tubing is not Necessary after Primary Endoscopic Dacryocystorhinostomy: A Prospective Randomized Study
Authors: Smirnov Grigori , Tuomilehto Henri , Terasvirta Markku , Nuutinen Juhani , Seppa Juha
Published: April 2008

Background

Endoscopic dacryocystorhinostomy (EN-DCR) is an effective procedure when treating saccal and postsaccal obstructions of the nasolacrimal pathway. The benefit of silicone tubing after DCR is still controversial. We conducted a prospective, randomized study to evaluate the necessity of bicanalicular silicone tubes after primary EN-DCR.

Methods

Forty-six consecutive primary EN-DCR procedures were performed in 42 patients during 2004-2007. The patients were randomized into two study groups according to whether silicone tubing was used or not.

Results

The overall success rate after primary EN-DCR was 89%: with silicone tubes it was 78%, and without silicone tubes it was 100%. The difference between these two groups was statistically significant (p < 0.049). The follow-up period was 6 months and included three follow-up visits: 1 week, 2 months, and 6 months postoperatively. If inserted, the silicone tubes were removed at the 2-month visit.

Conclusion

The results of our prospective, randomized study showed that the use of silicone tubes after primary EN-DCR is not necessary.
Allergic Profiles in Unilateral Nasal Polyps of Bilateral Chronic Rhinosinusitis
Authors: Li Jian-Yuan , Fang Sheen-Yie
Published: April 2008

Background

Bilateral chronic rhinosinusitis (CRS), with unilateral nasal polyps (NPs), is a good model for study, being characterized by a similar inflammatory reaction and environment in both nasal cavities of a subject, although NPs exist in only one nasal cavity. It may be feasible to identify specific pathological factors responsible for the disparities by comparing the differences between the nasal cavities.

Methods

In patients with bilateral CRS, polyp tissue and the middle turbinate tissue on the side of the polyp were examined and compared with contralateral nonpolyp middle turbinate tissue. Tissue and serum-specific immunoglobulin E (sIgE) levels were measured, and eosinophilic infiltration, interleukin (IL)-5 and IL-1-beta were assessed also in the polyp tissue.

Results

The presence of allergic symptoms correlated well with a positive serum CAP test but poorly with a positive tissue CAP test. There were no obvious differences between tissue sIgE levels on the NP side compared with the nonpolyp side. Tissue eosinophilia was a general characteristic of NPs, whether there was allergy or not. IL-5 and IL-1-beta levels were elevated in NPs, regardless of allergy. There were no differences in the specimens on the nonpolyp side between allergy and nonallergy groups.

Conclusion

With this model, we have more precise, however, not new results. Localized allergic reaction is not a major factor for the development of a unilateral polyp. Inflammation associated with eosinophilic infiltration and the presence of proinflammatory cytokines, including IL-5 and IL-1-beta, are more important in the pathogenesis of NPs than the allergic reaction.
Th2 Cytokines associated with Chronic Rhinosinusitis with Polyps Down-Regulate the Antimicrobial Immune Function of Human Sinonasal Epithelial Cells
Authors: Ramanathan Murugappan , Lee Won-Kyung , Spannhake Ernst W. , Lane Andrew P.
Published: April 2008

Background

Chronic rhinosinusitis with nasal polyps (CRSwNPs) is a disorder characterized by persistent eosinophilic Th2 inflammation and frequent sinonasal microbial colonization. It has been postulated that an abnormal mucosal immune response underlies disease pathogenesis. The relationship between Th2 inflammatory cytokines and the innate immune function of sinonasal epithelial cells (SNECs) has not been explored.

Methods

Human SNECs (HSNECs) isolated from control subjects and patients with CRS were assessed for expression of antimicrobial innate immune genes and proinflammatory cytokine genes by real-time polymerase chain reaction, ELISA, and flow cytometry. A model of the Th2 inflammatory environment was created by exposure of primary HSNEC to the Th2 cytokine interleukin (IL)-4 or IL-13 for 36 hours, with subsequent assessment of innate immune gene expression.

Results

HSNEC obtained from CRSwNP patients displayed decreased expression of multiple antimicrobial innate immune markers, including toll-like receptor 9, human beta-defensin 2, and surfactant protein A. Baseline expression of these genes by normal and CRS HSNEC in culture is significantly down-regulated after incubation with IL-4 or IL-13.

Conclusion

Expression of multiple innate immune genes by HSNEC is reduced in CRSwNP. One mechanism appears to be a direct effect of the leukocyte-derived Th2 cytokines present in the sinonasal mucosa in CRSwNP. Impaired mucosal innate immunity may contribute to microbial colonization and abnormal immune responses associated with CRSwNP.
Influence of Essential and Fatty Oils on Ciliary Beat Frequency of Human Nasal Epithelial Cells
Authors: Neher Andreas , Gstöttner Michaela , Thaurer Michael , Augustijns Patrick , Reinelt Monika , Schobersberger Wolfgang
Published: April 2008

Background

In alternative and complementary medicine, the use of essential and fatty oils has become more and more popular. In addition to conventional medical therapies, self-medication is showing increasing popularity, using agents with unclear compounds and poorly controlled dosages. Among other disorders, these alternative treatments are used in bronchitis and rhinitis, including some topical applications. Thus, the influence on ciliated epithelia should be evaluated, because a disturbance of the ciliary function can lead to recurrent sinusitis and chronic rhinosinusitis. The aim of this study was to test the influence of fatty and essential oils on the ciliary beat frequency (CBF) of nasal mucosa in vivo.

Methods

The influence of sesame oil, soy oil, peanut oil, Miglyol 840, thyme oil, lavender oil, eucalyptus oil, and menthol on the ciliary activity of nasal brushings was evaluated by digital high-speed imaging.

Results

The presence of most fatty oils resulted in an increase in CBF, the effect being highest for peanut oil. Miglyol 840 had no significant influence on CBF. The essential oils were tested at a concentration of 0.2 and 2%. Thyme oil did not affect CBF, whereas the presence of all other essentials oils resulted in an increase in CBF; the effect was higher at 0.2% than at 2%.

Conclusion

Except thyme oil and Miglyol 840, all tested oils caused an increase in CBF. Interestingly, the 0.2% concentrations of essential oils resulted in stronger effects when compared with the 2% concentrations.
Expression of Mammaglobins A and B in Nasal Polyps is Similar in Patients with and without Allergic Rhinitis
Authors: Chusakul Supinda , Phannaso Chuntima , Tongkobpetch Siraprapa , Aeumjaturapat Songklot , Poovorawan Yong , Suphapeetiporn Kanya , Shotelersuk Vorasuk
Published: April 2008

Background

The causes of nasal polyposis remain unclear. Mammaglobins have been implicated in its pathogenesis. However, their association with the occurrence of nasal polyps in the presence of allergic rhinitis (AR) has not been explored. The aim of this study was to compare the expression levels of mammaglobins A and B with the nasal polyps of patients with and without AR.

Methods

Thirty-one patients with bilateral nasal polyposis underwent skin-prick tests to specific aeroallergens. Nasal polyp tissues were obtained from all patients and divided into two groups as nasal polyps with and without AR depending on clinical history and the skin-prick test results. All polyp tissues were analyzed for the levels of mammaglobin A and mammaglobin B by using real-time quantitative polymerase chain reaction technique.

Results

Of the 16 samples from patients having nasal polyps with AR, only 1 sample expressed a detectable level of mammaglobin A (1/16). There was no detectable expression of mammaglobin A in tissues from the group of nasal polyps without AR (0/15). Expression of mammaglobin B was detected in all nasal polyp tissues from both groups. The expression of mammaglobin B was not significantly different between nasal polyps with AR (median, 25th-75th percentiles; 0.023, 0.013-0.046) and nasal polyps without AR (0.032, 0.007-0.16).

Conclusion

Expression levels of mammaglobins A and B in nasal polyps are not different between patients with and without AR. Our findings suggest that mammaglobins’ implication in the pathogenesis of nasal polyps is independent of an underlying AR.
Expression of Survivin and Enhanced Polypogenesis in Nasal Polyps
Authors: Qiu Zhe-Fu , Han De-Min , Zhang Luo , Zhang Wei , Fan Er-Zhong , Cui Shun-Jiu , Huang Qian , Wang Xiang-Dong
Published: April 2008

Background

The pathogenesis of nasal polyps still is not clear. This disease is believed to be inflammation related. Previous research has indicated that apoptosis in inflammatory cells is an important factor in the resolution of inflammation. Survivin is regarded as a novel member of the group of inhibitors of apoptosis proteins. It is overexpressed in a number of tumor types. The objective of this study was to investigate the expression of the survivin gene in human nasal polyps.

Methods

We investigated the expression of survivin in nasal polyps of adult patients with chronic rhinosinusitis. Specimens of nasal polyps were harvested during endonasal sinus surgery (n = 22), and the normal mucosa surrounding the nasal polyp tissues or inferior turbinate tissues served as control (n = 7). Immunohistochemical staining, reverse transcription polymerase chain reaction (RT-PCR), and Western blotting were performed for detecting the expression of survivin in the nasal polyps.

Results

This study has clearly shown that immunoreactivity of survivin significantly increased in the nasal polyp compared with nasal mucosa specimens surrounding nasal polyps (p < 0.001). The higher expression of survivin Western blotting and RT-PCR also was observed in the nasal polyp but not in normal nasal mucosa.

Conclusion

With a markedly increased expression of survivin in nasal polyps at both the mRNA and the protein levels, we believe the elevated expression of survivin might play an important role of the development in nasal polyps.
Orbital and Cranial Nerve Presentations and Sequelae are Hallmarks of Invasive Fungal Sinusitis caused by Mucor in Contrast to Aspergillus
Authors: Ingley Avani P. , Parikh Shatul L. , DelGaudio John M.
Published: April 2008

Background

Acute fulminant invasive fungal sinusitis (IFS) is a rapidly progressing, destructive process almost exclusively affecting immunocompromised patients. Outcome differences have been found in patients with Mucor and Aspergillus. We performed this study to compare the presenting symptoms and long-term morbidity with IFS caused by Mucor versus Aspergillus species.

Methods

Retrospective chart review was performed of 48 patients with 49 cases of acute fulminant IFS over a 19-year period. Presenting symptoms and long-term morbidity related to the orbits and cranial nerves were evaluated.

Results

Mucor was found in 22 cases and Aspergillus was found in 27 cases. Orbital (proptosis, periorbital edema, and ophthalmoplegia) and cranial nerve symptoms were seen at presentation more often in Mucor (6 [27%] and 9 [41%]) than in Aspergillus patients (3 [11%] and 7 [26%]; p = 0.079). Long-term orbital and cranial nerve sequelae occurred in 16 (72%) Mucor cases and 10 (37%) Aspergillus cases (p = 0.0210). The IFS-related mortality was 32% (7) in the Mucor group and 11% (3) in the Aspergillus group (p = 0.089).

Conclusion

Patients with acute fulminant IFS present with similar sinus symptoms; however, there is a trend toward a greater prevalence of orbital and neurological symptoms in patients with Mucor versus Aspergillus. Long-term orbital and neurological morbidity is more prevalent in patients with Mucor compared with Aspergillus. These data suggest that the presence of orbital and neurological symptoms at presentation warrants more aggressive surgical intervention because of the likelihood of Mucor.
The Roles and Limitations of Computed Tomography in the Preoperative Assessment of Sinonasal Inverted Papillomas
Authors: Sham C.L. , King Ann D. , van Hasselt Andrew , Tong Michael C.F.
Published: April 2008

Background

Preoperative radiological assessment of sinonasal inverted papilloma (SNIP) is important in the planning of surgical treatment. This study investigates the roles and limitations of preoperative plain computed tomography (CT) scan in the preoperative assessment of SNIP.

Methods

Plain CT scans from 30 patients with SNIP were reviewed retrospectively by a radiologist who had no prior knowledge of the final surgical findings. Disease at each sinus was judged by the CT findings of opacity and additional signs. The overall disease was staged according to the staging system proposed by Krouse. All of the findings were compared with the final disease extent and staging confirmed by intraoperative and histological findings.

Results

Using opacity with additional signs for diagnosis, the range of accuracy of CT diagnosis for each sinus involvement was 83-97%. Staging by plain CT was concordant with postoperative staging in 80% of patients. Among the additional signs, focal hyperostosis or “bony strut” had the highest positive predictive value (100%) of tumor origin.

Conclusion

Focal hyperostosis or bony strut is the most important CT sign predicting the origin of tumor. Although using multiple CT diagnostic signs provides a reasonable assessment of tumor origin and extent, accurate tumor mapping was still impossible because of inadequate differentiation of tumor from inflammatory pathologies. This drawback may be overcome by a complementary MRI scan. Since preoperative CT staging was inaccurate in 20% of cases, surgical planning should be flexible to provide for the need of the intraoperative findings.
Effect of Postural Change on Nasal Airway and Autonomic Nervous System Established by Rhinomanometry and Heart Rate Variability Analysis
Authors: Ko Jen-Hung , Kuo Terry B.J. , Lee Guo-She
Published: April 2008

Background

Clinically, nasal obstruction is experienced frequently in the supine position, and the nasal autonomic nervous system (ANS) may be involved in the mechanism. The central ANS functions at maintaining cardiovascular hemodynamics. However, during postural change, the corresponding changes of the central ANS may simultaneously change the nasal airway as well. In this study, the relationships between nasal ANS and central ANS were explored using rhinomanometry (RMM) and heart rate variability (HRV) analysis between postural changes.

Methods

Twelve healthy volunteers aged between 19 and 39 years and without a history of allergic rhinitis or significant nasal anatomic obstruction were enrolled for the study. The nasal airway was measured using RMM in a sitting position and then in a supine position; the electrocardiography was simultaneously recorded.

Results

In supine position, the total nasal airflow significantly decreased and the airway resistance significantly increased (p < 0.05, Wilcoxon signed-rank test). The ratio of low frequency power to high frequency (HF) power of HRV that represents sympathetic modulation significantly decreased in the supine position (p < 0.05, Wilcoxon signed-rank test). However, the HF that represents parasympathetic activity did not show significant change with postural change. The correlations of heartbeat interval with total inspiratory airflow and total inspiratory resistance were significant also (p < 0.01, Pearson's correlation).

Conclusion

The central ANS activities significantly correlated with changes to the nasal airway during postural change. The central ANS, especially the sympathetic nervous system, may play a role in controlling nasal airway during postural change.
A Randomized Controlled Pilot Study of Epsilon-Aminocaproic Acid as a Topical Hemostatic Agent for Postoperative Bleeding in the sheep Model of Chronic Sinusitis
Authors: Thomas Devika C. , Wormald Peter-John
Published: April 2008

Background

Significant bleeding with blood clot formation in the postoperative period may predispose to the formation of postoperative adhesions. A topical hemostatic agent would potentially improve postoperative comfort and lessen adhesion formation. This pilot study was performed to evaluate the effects of a novel topical hemostatic agent AMICAR (e-aminocaproic acid; Xanodyne Pharmacal, Inc., Florence, KY) on postoperative bleeding after endoscopic sinus surgery (ESS).

Methods

In a prospective randomized controlled pilot study full thickness mucosal injuries were created on the lateral nasal wall, ethmoturbinal and the maxillary ostium on both sides of 10 sheep. Eosinophilic chronic sinusitis was confirmed both by endoscopy and by biopsy before full thickness injuries. The topical hemostatic agent (AMICAR) was sprayed onto a randomly selected side with or without mucoadhesive methyl cellulose (5 sheep in each group). The control side received a spray of saline of equal volume. The degree of bleeding in the surgical field was graded using a visual analog scale until total hemostasis was achieved. The grades at 2-minute intervals as well as the time to achieve total hemostasis were recorded.

Results

Eosinophilia of the epithelium did not correlate with the severity of bleeding (p < 0.05). There was a statistically significant reduction in the grade of bleeding in the lateral nasal wall both superior and inferior to the middle turbinate attachment when AMICAR alone was used compared with normal saline (p = 0.004 and p = 0.003, respectively) but when AMICAR was used in combination with methyl cellulose this significance was lost (p = 0.076 and p = 0.502).

Conclusion

AMICAR may be considered for use either during or after sinus surgery to reduce bleeding.
The Impact of Septodermoplasty and Potassium-Titanyl-Phosphate (KTP) Laser Therapy in the Treatment of Hereditary Hemorrhagic Telangiectasia-Related Epistaxis
Authors: Harvey Richard J. , Kanagalingam Jeeves , Lund Valerie J.
Published: April 2008

Background

A variety of modalities are available for the control of recurrent epistaxis in hereditary hemorrhagic telangiectasia (HHT). Laser ablation, in particular potassium-titanyl-phosphate (KTP), has gained popularity as it coagulates the telangiectasia with minimal peripheral tissue injury. Septodermoplasty (SDP) also can be performed in the day surgery setting. Telangiectasia recurred, necessitating repeated treatments. The frequency and interval between procedures is not well documented. The purpose of this study was to describe the frequency of surgical interventions for HHT patients and the impact of SDP.

Methods

A retrospective review was undertaken of procedures performed in a tertiary hospital unit during a 60-month period for HHT. The incidence of KTP laser and SDP, days between treatments, total number of interventions and perioperative hemoglobin (Hb) were audited. Patient groups were identified as definite or possible HHT according to the Curacao criteria. All suffered from epistaxis sufficient to seek medical treatment.

Results

Three hundred one procedures were performed on 131 patients during the study period. In total, 33 SDPs and 268 KTP laser treatments were performed; 78.3% of patients required three or less procedures. The mean time interval between treatments was 473 (±515 days) days. The rate of KTP after an SDP decreased from 1.83 (±1.99) to 0.78 (±0.85; p = 0.012). Hb level was not associated with treatments required.

Conclusion

Surgical interventions with laser and SDP in HHT are always time limited as recurrence of telangiectasia is inevitable. This study discusses the expectations of therapy, mainly frequency and duration of effect, along with the impact of SDP. The outcomes assist in better management of patient expectations.
Effects of Sinus Surgery on lung Transplantation Outcomes in Cystic Fibrosis
Authors: Leung Man-Kit , Rachakonda Leelanand , Weill David , Hwang Peter H.
Published: April 2008

Background

In cystic fibrosis (CF) patients who are candidates for lung transplant, pretransplant sinus surgery has been advocated to avoid bacterial seeding of the transplanted lungs. This study reviews the 17-year experience of pretransplant sinus surgery among CF patients at a major transplant center.

Methods

Retrospective chart review was performed in all CF patients who underwent heart-lung or lung transplantation at Stanford Medical Center between 1988 and 2005. Postoperative culture data from bronchoalveolar lavage (BAL) and sinus aspirates were evaluated, in addition to survival data.

Results

Eighty-seven CF transplant recipients underwent pretransplant sinus surgery; 87% (n = 59/68) of patients showed recolonization of the lung grafts with Pseudomonas on BAL cultures. The median postoperative time to recolonization was 19 days. Bacterial floras cultured from sinuses were similar in type and prevalence as the floras cultured from BAL. When compared with published series of comparable cohorts in which pretransplant sinus surgery was not performed, there was no statistically significant difference in the prevalence of Pseudomonas recolonization. Times to recolonization also were similar. Survival rates in our cohort were similar to national survival rates for CF lung transplant recipients.

Conclusion

Despite pretransplant sinus surgery, recolonization of lung grafts occurs commonly and rapidly with a spectrum of flora that mimics the sinus flora. Survival rates of CF patients who undergo prophylactic sinus surgery are similar to those from centers where prophylactic sinus surgery is not performed routinely. Pretransplant sinus surgery does not appear to prevent lung graft recolonization and is not associated with overall survival benefit.
Asthma Outcomes after Endoscopic Sinus Surgery in Aspirin-Tolerant versus Aspirin-Induced Asthmatic Patients
Authors: Awad Osama G. , Fasano Mary Beth , Lee John H. , Graham Scott M.
Published: April 2008

Background

Certain diseases affect both upper and lower airways. Aspirin-induced asthma (AIA) is a clinical entity characterized by asthma, nasal polyposis, and aspirin intolerance. To understand the response of the lower airway to surgical treatment of the sinuses, we examined asthma outcomes in AIA compared with a second group of aspirin-tolerant asthmatic (ATA) patients to establish if there were any differences between the two groups after endoscopic sinus surgery (ESS).

Methods

A retrospective record review was performed of 91 asthmatic subjects with chronic rhinosinusitis. Forty-one subjects had AIA and 50 subjects had ATA. Subjective and objective asthma outcome parameters were used to compare between the two groups at three time points: immediately before ESS and 6 and 12 months after ESS.

Results

Preoperatively, AIA patients had significantly higher asthma severity (p < 0.0001) and lower forced expiratory volume in 1 second values (p = 0.04). At 12 months after ESS, a statistically significant difference between the two groups with better results in AIA patients was seen in asthma severity improvement (p = 0.010) and in the decrease of ICS doses (p < 0.0001), without significant differences between the two groups in other asthma outcome parameters.

Conclusion

AIA patients usually present with more severe asthma. The asthmatic complaints of AIA and ATA patients continue to improve significantly over 6 and 12 month after ESS. Although ESS helped both groups of patients, AIA had statistically significant better results compared with ATA patients in asthma severity scores and decreased need for ICS.
Outcomes of Posterior Lacrimal Sac Approach in Endoscopic Dacryocystorhinostomy: Review of 35 cases
Authors: Lee Kyung Chul
Published: April 2008

Background

The purpose of this study was to describe the posterior lacrimal sac approach in endoscopic dacryocystorhinostomy (DCR) performed at our institute and report perioperative results achieved with this procedure.

Methods

A prospective clinical study was performed of 35 adult patients with nasolacrimal duct obstruction who underwent posterior lacrimal sac approach DCR from March 1998 to May 2005. Follow-up period ranged from 13 to 30 months (average, 17.5 months; SD, 6.8 months). “Surgical success” was defined as complete relief of epiphora and patent surgical ostium on endoscopic assessment.

Results

Surgical success was achieved in 30/35 (85.7%) patients after the primary surgery. Of 5 unsuccessful patients who complained of occasional epiphora, 4 patients had formed stenosis and 1 patient had granulation around the surgical opening, and all had revision surgery. Four of 5 (80.0%) patients achieved surgical success. Thus, including the result of revision surgery, 34/35 (97.1%) patients were successful.

Conclusion

Posterior lacrimal sac approach in endoscopic DCR has several advantages: good sac accessibility, a low complication rate, and a relatively high success rate. Therefore, the posterior lacrimal sac approach appears to offer a useful alternative approach for the surgical treatment of nasolacrimal duct obstruction.
Utility of Preoperative High-Resolution CT and Intraoperative Image Guidance in Identification of Cerebrospinal Fluid Leaks for Endoscopic Repair
Authors: Zuckerman Jodi D. , DelGaudio John M.
Published: April 2008

Background

Endoscopic repair of cerebrospinal fluid (CSF) leaks is a well-established procedure. The radiological workup and use of intraoperative image guidance (IGS), lumbar drain (LD), and intrathecal fluorescein (IF) are less universally accepted. This study examines endoscopic repair of CSF leaks using preoperative high-resolution CT (HRCT) and intraoperative IGS without IF or LD.

Methods

Retrospective review was performed of a single surgeon experience between September 2002 and January 2007.

Results

Forty-two anterior skull base defects in 40 patients were repaired endoscopically. The etiology of CSF leaks was traumatic in 5, spontaneous in 12, and iatrogenic in 25 defects (15 from endoscopic sinus surgeries and 10 from neurosurgical procedures). Fifty-two percent of defects presented with a meningoencephalocele. Defect location was sphenoid sinus (17 defects), ethmoid roof (14 defects), cribriform plate (9 defects), and frontal sinus (2 defects). Defect size ranged from 1 X 1 mm to 2 X 2 cm. Follow-up ranged from 8 to 46 months. All defects were identified preoperatively on HRCT with successful intraoperative IGS localization. No patients required IF for identification of CSF leak. Overall successful repair was achieved in 40 (95%) defects after initial repair, and 100% after revision. Seven patients had LD, 6 patients were early in the series. Twenty-three patients were discharged the day after surgery and 6 patients were discharged on day 2.

Conclusion

Using preoperative HRCT for diagnosis and intraoperative IGS for localization, even small skull base defects can be definitively identified. High success rates and early discharges are achieved without additional procedures such as IF or LD. This is a less invasive and more cost-efficient method of repairing CSF leaks.
Serum Inflammatory Protein Profiles in Patients with Chronic Rhinosinusitis Undergoing Sinus Surgery: A Preliminary Analysis
Authors: Becker Adam M. , Das Subinoy , Xia Zhongsheng , Liu Zhongmin , Adam Bao-Ling , Kountakis Stilianos E.
Published: April 2008

Background

The specific aim of this study was to evaluate surface-enhanced laser desorption/ionization time-of-flight mass spectroscopy (SELDI-TOF-MS) as a clinical screening tool in differentiating patients with chronic rhinosinusitis (CRS) from healthy control patients.

Methods

Serum samples were prospectively collected at a tertiary care academic medical center from 96 CRS patients who underwent functional endoscopic sinus surgery (FESS) and 38 control volunteers who were negatively screened according to the Rhinosinusitis Task Force guidelines on CRS. SELDI-TOF-MS was performed on serum samples to detect protein profiles in the range of 1-100 kDa. Analysis of spectral data was performed to determine the sensitivity and specificity of SELDI-TOF-MS in distinguishing patients with CRS requiring FESS from healthy controls and to determine potential markers for protein purification.

Results

Serum protein profiles generated from SELDI-TOF-MS in the range of 1-100 kDa were analyzed. Classification and regression tree analysis based on peak expression correctly classified patients with CRS with 77.1% sensitivity and 65.8% specificity, a positive predictive value of 88%, and a negative predictive value of 53%. Underexpression of a protein peak at 8.4 kDa was associated with CRS in 77% of cases.

Conclusion

SELDI-TOF-MS serum protein profile analysis is able to distinguish CRS patients requiring FESS from healthy, negatively screened controls with a sensitivity of 77.1% and specificity of 65.8%. Additional investigation is required to determine if SELDI-TOF-MS will make an effective clinical tool.
The use of Portable Intraoperative Computed Tomography Scanning for Real-Time Image Guidance: A Pilot Cadaver Study
Authors: Das Subinoy , Maeso Patricia A. , Figueroa Ramon E. , Senior Brent A. , Delgaudio John M. , Sillers Michael J. , Schlosser Rod J. , Kountakis Stilianos E.
Published: April 2008

Background

This study was performed to assess the feasibility of using intraoperative computed tomography (CT) to provide real-time updates to image guidance systems (IGSs) during surgery.

Methods

The xCAT ENT portable intraoperative CT scanner (Xoran Technologies, Ann Arbor, MI) was used to acquire scans before, midway, and at the end of six cadaver dissections during the Southern States Rhinology Course, Augusta, GA, in October 2006. These scans were used to recalibrate three different IGSs used during the dissection. Time measurements were recorded and dosimetry was obtained from the cornea, sphenoid sinus (near the optic chiasm), and from the operative field during acquisition of the images. IGS accuracy was determined at the skull base and lamina papyracea. Surgeons were interviewed on benefits of real-time updates to the IGS after completion of dissections.

Results

The xCAT ENT scanner was compatible with all three IGS platforms. The average time to update the IGS was 13 minutes. Radiation doses to the cornea were 620 mrad per scan, and optic chiasm was 800 mrad/scan. The accuracy at the anterior skull base improved from 1.58 to 0.62 mm (p = 0.026). The accuracy at the posterior skull base improved from 1.46 to 0.71 mm (p = 0.014). The accuracy at the lamina was not significantly changed.

Conclusion

Intraoperative portable CT scanning with real-time IGS updates is feasible and likely would add little additional time. Accuracy is improved at the skull base. Prospective studies on actual patients are warranted.
Use of Intraoperative CT Scanning in Endoscopic Sinus Surgery: A Preliminary Report
Authors: Jackman Alexis H. , Palmer James N. , Chiu Alexander G. , Kennedy David W.
Published: April 2008

Background

Image-guided functional endoscopic sinus surgery (IG- FESS) using preoperatively acquired CT images for navigation has been proven to facilitate complicated endoscopic sinus procedures and decrease the need for revision procedures. However, this system does not render the intraoperative anatomic changes that occur throughout the procedure. The purpose of this study is to show the technical feasibility and the potential impact of intraoperative CT scanning in conjunction with real-time update of computer-assisted navigation during ESS.

Methods

Intraoperative CT scanning was performed in selected patients undergoing FESS. A scan was taken before the conclusion of surgery performed by skilled endoscopic sinus surgeons. The scans were evaluated for residual disease or cellular partitions. Where indicated, intraoperative scan was then loaded into the image guidance system and intraoperative scans were then used for additional IGS. The scan findings were documented.

Results

Intraoperatively acquired CT scans were obtained successfully in <40 seconds and able to be loaded into the image guidance system within minutes. All surgeries were preformed without complication. New information obtained from the intraoperative CT scan led to alteration in the surgical plan in 30% of patients.

Conclusion

Intraoperative CT scanning can be preformed with currently available technology and has the potential to improve the extent of surgery in patients with complicated anatomy and extensive disease.
In Vitro Effects of Preservatives in Nasal Sprays on Human Nasal Epithelial Cells
Authors: Ho Ching-Yin , Wu Meng-Chuan , Lan Ming-Ying , Tan Ching-Ting , Yang An-Hang
Published: April 2008

Background

The preservatives benzalkonium chloride and potassium sorbate are widely used in nasal drops and sprays. Recently, side effects resulting from mucosal damage caused by benzalkonium chloride and potassium sorbate were reported.

Methods

We investigated the toxicity of benzalkonium chloride and potassium sorbate on human nasal epithelial cells in vitro. Using primary human nasal epithelial cells, different concentrations of benzalkonium chloride, potassium sorbate, or phosphate-buffered saline (PBS; control group) solutions were cocultured with nasal epithelial cells for 15 minutes. Then, the viability of the cells and the cell morphology were assessed.

Results

Nasal epithelial cells were more severely damaged with use of clinical preparations or higher concentrations of benzalkonium chloride than in the control group. In addition, nasal epithelial cell membrane lysis was seen on electronic microscopy in the benzalkonium chloride groups. In contrast, there was no significant cell damage seen in the potassium sorbate groups compared with the control group, even with higher concentrations than clinically used.

Conclusion

Potassium sorbate appears to be a relatively safer preservative than benzalkonium chloride for use in nasal sprays and drops in vitro study.
Functional Endoscopic Dilatation of the Sinuses: Patient Satisfaction, Postoperative Pain, and Cost
Authors: Friedman Michael , Schalch Paul , Lin Hsin-Ching , Mazloom Narges , Neidich Marci , Joseph Ninos J.
Published: April 2008

Background

The purpose of this study was to determine how functional endoscopic dilatation of the sinuses (FEDS) compares with functional endoscopic sinus surgery (FESS) in a select group of patients with respect to (1) elimination of symptoms, (2) patient satisfaction, (3) postoperative narcotic use, and (4) cost. A retrospective study was performed of 70 patients with chronic rhinosinusitis who underwent FEDS or FESS as primary or revision treatment.

Methods

Symptoms and satisfaction based on the Sino-Nasal Outcome Test (SNOT-20) questionnaires and global patient assessment, postoperative narcotic use, and costs were compared after 3-month follow-up.

Results

SNOT-20 change scores indicated that both FEDS and FESS had clinically meaningful treatment responses. Patient satisfaction was higher and postoperative narcotics usage was less with FEDS. The cost for primary procedures was similar, whereas the cost for revision surgery using FEDS was considerably less. Turbinate lateralization and scarring was more common in the FEDS group, particularly early in the study. The incidence of recurrent sinus infections during the follow-up period was similar for both groups. Only one patient in the FEDS group required a repeat intervention within the short-term follow-up period.

Conclusion

Both FEDS and FESS resulted in significant improvement in SNOT-20 scores for selected patients with mild disease. Patient satisfaction and postoperative narcotic use of FEDS compare favorably with FESS. Cost of FEDS was comparable with FESS for primary procedures but was less than FESS for revision procedures. Long-term efficacy and final cost of FEDS remain to be addressed, taking into account the need for revision procedures after initial FEDS, by means of long-term studies and objective outcome measures.
Long-Term Endonasal Endoscopic Review of Successful Duraplasty after Endonasal Endoscopic Skull Base Surgery
Authors: El-Banhawy Omar A. , Halaka Ahmed N. , Ayad Heshmat , El-Altuwaijri Mohammed , El-Sharnoby Mohamed M.
Published: April 2008

Background

This study was performed to examine the long-term endonasal endoscopic morphological appearance of successful duraplasty after endoscopic skull base surgery for different pathology.

Methods

This study included 65 patients who underwent endonasal endoscopic surgery for different skull base lesions with successful duraplasty. Forty patients had pituitary adenomas, 25 with macroadenomas and 15 with microadenomas. Twenty patients with cerebrospinal fluid rhinorrhea of different etiologies and three patients with meningoencephalocele were included. There were two patients with skull base meningiomas, 1 with an extensive greater wing meningioma reaching the nasal cavity and the 1 with recurrent olfactory groove meningioma. Different types of autologous materials were used in reconstructing the skull base defect. Clinical follow-up with endoscopic nasal examination was done routinely 1, 3, 6, and 12 months after surgery. CT and MRI were performed when indicated. The follow-up period ranged from 6 months to 8 years.

Results

Starting from 3 months after surgery to the rest of the follow-up period, endonasal endoscopic view of the site of duraplasty showed that with small skull base defect (<5 mm), there was neither dural pulsation nor prolapse. With moderate-size defect (5-10 mm) there was dural pulsation without prolapse. With larger defect (>10 mm) there was dural pulsation and prolapse. These findings were constant regardless of the etiology of the lesion and the reconstruction material used.

Conclusion

This long-term study showed that dural pulsation and prolapse at the site of the successful duraplasty is a function of the size of the bony defect and does not depend on the pathology of the lesion or the autologous material used for reconstruction. For any future endonasal procedure for these patients, the surgeons should be fully aware of the state of duraplasty to avoid any complication.