bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nitric Oxide and Collagen Expression in Allergic Upper-Airway Disease
Authors: Tewfik Marc A. , Bernardes Julio F. , Shan Jichuan , Robinson Michelle , Frenkiel Saul , Eidelman David H. 
Published: August 2018

Background The presence of nitric oxide (NO) in high concentrations has been described in the nasal mucosa of patients with untreated allergic rhinitis. We sought to examine the role of exogenous, as well as endogenous, NO in the production of collagen type I and type III by human nasal fibroblasts. Methods Primary cultured fibroblasts derived from eosinophilic nasal polyps were exposed to NO donors (500 μM of S-nitroso-N-acetyl-d,l-penicillamine (SNAP) 1000 μM of 3,3-bis(aminoethyl)-1-hydroxy-2-oxo-1-triazene (DETA-NONOate)) and various other compounds over a 24-hour incubation period. Collagen production was evaluated qualitatively by immunocytochemistry and quantitatively by Western blot analysis. Results Maximally stimulated fibroblasts established a 2.2-fold increase in the production of type III collagen relative type I, as compared with baseline. Oxyhemoglobin, an NO scavenger, abolished this effect. SNAP (500 μM) caused a 15.68 ± 0.68% increase in collagen type I synthesis as compared with unstimulated controls (p < 0.05). In contrast, incubation with SNAP caused an increase in collagen type III production by a factor of 34.68 ± 0.32% (p < 0.05). Conclusion NO stimulates collagen expression in human nasal polyp-derived fibroblasts. This stimulation appeared to favor the up-regulation of collagen type III, leading to a shift in the ratio of collagen type I to type III production.
Low-Grade Fibrosarcoma of the Anterior Skull Base: Endoscopic Resection and Repair
Authors: Kuhn Frederick A. , Javer Amin R. 
Published: August 2018

Background Fibrosarcomas of the paranasal sinuses and skull base are uncommon tumors. Traditionally, “open approach” surgery remains the mainstay for treatment of choice for these tumors. Methods A 49-year-old man underwent resection of a right anterior skull base fibrosarcoma using the endoscopic approach. Results Close follow-up using both endoscopic and imaging methods over a period of four years has revealed a well-healed skull base with no evidence of recurrence. Conclusion Significant resistance exists at present for such a technique to deal with malignant diseases of the head and neck, but results from advanced centers continue to prove that this may be a technique worth mastering and improving on.
Fungal DNA is Present in Tissue Specimens of Patients with Chronic Rhinosinusitis
Authors: Gosepath Jan , Brieger Juergen , Vlachtsis Konstantin , Mann Wolf J. 
Published: August 2018

Background It has been postulated that fungal organisms might represent the immunologic target initiating and maintaining the disease process in patients with chronic rhinosinusitis (CRS). The presence of fungi in nasal mucus has been established by different groups, but so far it has not been shown how the immune system could even recognize such extramucosal—extracorporal—fungal targets. The aim of this study was to determine whether fungal DNA is present in tissue specimens taken from patients with polypoid CRS. Methods Twenty-seven surgical specimens were collected from patients suffering from CRS. Fifteen surgical specimens from healthy ethmoidal mucosa served as controls. A second set of controls consisted of five surgical specimens of acoustic neuroma, which were included to rule out contamination within the protocol. All paranasal tissue samples were treated and rinsed carefully with a solution of Dithiothreitol to digest any nasal mucus and ensure that only tissue was examined. A highly sensitive two-step polymerase chain reaction (PCR) was applied to detect fungal DNA, using one universal primer for unspecific detection of fungal DNA and a second primer pair specific for Alternaria. Results Fungal DNA was detected in all 27 CRS specimens equally with both PCR primers. Controls from healthy paranasal mucosa were positive using the panfungal primers in 10 of 15 cases but were all negative for Alternaria DNA. PCR was negative for fungal DNA in all five neuroma specimens. Conclusions Fungal DNA can be detected within sinonasal tissue specimens of patients suffering from CRS. These findings need to be discussed with respect to the proposed hypothesis of the immune system recognizing extramucosal organisms and initiating an immune response in sensitized patients.
Immediate Correction of Nasal Septum Dislocation in Newborns: Long-Term Results
Authors: Tasca Ignazio , Ceroni Compadretti Giacomo 
Published: August 2018

Background The authors present the results of a long-term follow-up after an immediate reduction of nasal septum luxation in newborn infants. Methods Forty-nine children, who underwent a treatment for septal dislocation within 48 hours after birth, were reexamined in 2002 at a mean age of 13.2 years (range, 10–17 years). The examination was performed through inspection of the nasal pyramid, anterior rhinoscopy, nasal endoscopy, rhinomanometry, and acoustic rhinometry. Results Anatomic and functional findings showed satisfactory results for all children affected by septal dislocation. Three patients presenting irreplaceable septal-pyramidal deformity had no spontaneous reduction at 7-, 10-, and 11-year follow-ups and thus required surgical intervention. Conclusions Considering the simplicity and the safety of the reduction maneuver, the importance of early detection and treatment of neonatal septal dislocations is stressed. This is the longest follow-up study reported in international literature to date.
The Nasal Valve: A Review of the Anatomy, Imaging, and Physiology
Authors: Wexler David B. , Davidson Terence M. 
Published: August 2018

Background The nasal valve region has remained difficult to define in clinical practice in part because of lack of integration between physiological data and anatomic-surgical findings. Methods In this review, we summarize the anatomic, physiological, and imaging data regarding this complex area of airflow regulation. Results There is no singular resistive focus or singular valve structure to explain all of the reported findings. Conclusion We conclude that there is a nasal valve region that begins approximately at the limen nasi and continues for several millimeters within the nasal cavum beyond the piriform aperture. Intranasal pressure measurements reflect distributed resistance across this nasal valve region. The geometry and anatomic constitution of the nasal valve region change greatly from its entrance to its distal aspect. To refer consistently to the component portions of the nasal valve region, we suggest the terms cartilaginous valve segment and bony valve segment for use in reporting future studies.
Histopathological Features of Nasal Polyps with Asthma Association: An Immunohistochemical Study
Authors: Haruna Shinichi , Nakanishi Marcio , Otori Nobuyoshi , Moriyama Hiroshi 
Published: August 2018

Background Myofibroblasts are related to airway remodeling and may play an important role in the pathogenesis of the histological features of nasal polyps associated with asthma. The aim of this study was to analyze and compare the eosinophilic cationic protein, transforming growth factor (TGF) β, and myofibroblasts in the nasal polyps of patients with chronic sinusitis associated with and without asthma. Methods Nasal polyp samples were obtained during endoscopic sinus surgery and were classified into asthma and nonasthma groups. Immunohistochemistry was performed using antibodies against activated eosinophils, TGF-β, and myofibroblasts. Results The asthma group showed an increased number of activated eosinophils, TGF-β, and myofibroblasts compared with the nonasthma and control groups. We found no correlation of asthma and aspirin intolerance with the immunohistochemical findings. Conclusion The increased number of myofibroblasts in the nasal polyps of the asthma group may be responsible for the extracellular matrix accumulation, polyp formation, and polyp recurrence.
The Effect of the Modified Endoscopic Lothrop Procedure on the Mucociliary Clearance of the Frontal Sinus in an Animal Model
Authors: Rajapaksa S.P. , Ananda A. , Cain T. , Oates L. , Wormald P.-J. 
Published: August 2018

Background The surgical management of recalcitrant frontal sinus disease has been a dilemma for otolaryngologists for many years. Although the osteoplastic flap with obliteration has been the gold standard of treatment for years, the modified endoscopic Lothrop (MEL) procedure recently has been advocated as an alternative. However, little is known about the effect of this procedure on the mucociliary drainage of the frontal sinuses postoperatively and this animal study addresses this issue. Methods Fourteen sheep underwent the MEL procedure. The sheep were randomized regarding the use of postoperative irrigation via minitrephines. Each sheep had a nuclear medicine γ-scintigraphy frontal sinus clearance study via minitrephines performed on each frontal sinus preoperatively and then 3 months postoperatively. Then, the results of these studies were compared. Results The scans revealed a trend toward faster clearance times postoperatively. However, this decrease was not statistically significant. Importantly, there was no trend or significant increase in clearance times postoperatively. Also, the use of postoperative irrigation was associated with a nonsignificant trend toward faster clearance times postoperatively. Conclusion The MEL procedure has no adverse effects on the mucociliary clearance of the frontal sinus at 3 months postoperatively. Irrigation of the frontal sinus in the immediate postoperative period showed a trend toward improved postoperative mucociliary function at 3 months.
Midline Necrotizing Nasal Lesions: Analysis of 18 Cases Emphasizing Radiological and Serological Findings with Algorithms for Diagnosis and Management
Authors: Westreich Richard W. , Lawson William 
Published: August 2018

Background The aim of this study was to assess the principal signs and symptoms for severe necrotizing midline nasal lesions and give diagnostic and management algorithms. Methods Literature review and retrospective chart review were performed. Three patients with Wegener's granulomatosis (WG), six patients with sarcoid, eight patients with cocaine abuse, and one lymphoma patient were analyzed with respect to symptom complexes, laboratory results, and radiographic findings. Based on computed tomography findings, a nasal destruction score was tabulated for each patient. Results All diseases essentially had similar signs and symptoms within the head and neck but several extranasal sites were suggestive of specific etiologies. Serological laboratory testing was diagnostic in only two of the six sarcoid patients and two of the three WG patients. There were no specific tests associated with lymphoma or cocaine abuse, although erythrocyte sedimentation rate was consistently and significantly elevated in the latter group. Biopsy confirmed disease was found in one of the three sarcoid patients, in one of the three WG patients, and in one out of one of the lymphoma patients. Nasal destruction scores were highest in WG and lymphoma patients, intermediate in cocaine abuse patients, and lowest in patients with sarcoidosis. Two of the three WG patients had extensive neo-osteogenesis. One out of one lymphoma and five of the eight cocaine abuse patients had oronasal or oroantral fistulas. Conclusion Laboratory tests and biopsies were consistently unreliable in all diseases. Repeat studies should be performed in all cases of negative results if clinical suspicion is high. Neo-osteogenesis and mastoid disease were associated with WG when compared with patients with similar levels of nasal destruction due to other etiologies. Laryngeal and dermatologic changes without significant nasal bony abnormalities raised suspicion for sarcoidosis. Hard and soft palate defects were associated with cocaine abuse and extranodal nasal lymphoma.
Endoscopic Resection of Sinonasal Malignancies: A Preliminary Report
Authors: Roh Hwan-Jung , Batra Pete S. , Citardi Martin J. , Lee Joung , Bolger William E. , Lanza Donald C. 
Published: August 2018

Background A minimally invasive endoscopic approach for the management of sinonasal malignancy offers several advantages including excellent illumination, maximal preservation of uninvolved vital structures, and sparing of facial incisions. The purpose of this study was to evaluate the outcome and morbidity of endoscopic resection with or without combined radiotherapy and/or chemotherapy. Methods Forty-seven patients with sinonasal malignancy were diagnosed and/or treated with an endoscopic approach at The Cleveland Clinic Foundation and The University of Pennsylvania Medical Center from 1996 to 2003. Nineteen patients fulfilled the study criteria and had a minimally invasive endoscopic resection. Fifteen patients were treated with curative intent and four patients underwent palliative resection. Results The mean age was 56.9 (9–78 years) years and the mean follow-up period was 26.4 months. Combined radiation with or without chemotherapy pre- or postoperatively was given to 15 of 19 (78.9%) patients. Thirteen patients were resected strictly with an endoscopic approach and six patients were resected in combination with neurosurgery. There were no peri- and postoperative deaths. The local recurrence (LR) rate was 26.3% (5/19) and the distant metastasis rate was 15.8% (3/19). Overall survival rate (OS) was 78.9% (15/19) at a mean follow-up duration of 32.1 (4–74 months) months. The disease-free survival (DFS) rate was 68.4% (13/19) by clinical, endoscopic, and radiographic surveillance at a mean follow-up duration of 33.1 months. Patients treated with curative intent had LR, OS, and DFS rates of 21.4, 85.7, and 85.7%, respectively, and the patients treated for palliation had LR, OS, and DFS rates of 40, 60, and 15%, respectively. Conclusion Minimally invasive endoscopic resection of sinonasal malignancy in combination with adjunctive therapies reduces treatment morbidity and yields LR, OS, and DFS rates that are comparable with traditional anterior craniofacial approaches.
Outcomes of Frontal Mucocele Marsupialization: Endonasal and External Approaches
Authors: Nakanishi Marcio , Haruna Shinichi , Wada Kota , Otori Nobuyoshi , Moriyama Hiroshi 
Published: August 2018

Background Frontal sinus mucoceles are known to undergo repeated recurrences, and the management of this disease constitutes a challenge regarding the ideal treatment. The aim of this study was to evaluate the postoperative results of the endoscopic ventilation approach in the treatment of frontal mucoceles. Methods We retrospectively reviewed the charts of 24 subjects with mucocele who underwent endoscopic marsupialization. The preoperative characteristics of the frontal sinus on computed tomography scans were compared with the postoperative results. Results Postoperative endoscopic examination revealed in 15 nasal sides wide patency of the frontal outflow tract. The ostium was patent but had become slightly narrowed in nine nasal sides. Restenosis of the ostium was found in six cases. Conclusion A membranous type of obstruction in the region of the frontal outflow tract was related to a better outcome.
Endoscopic Management of Failed Frontal Sinus Obliteration
Authors: Chandra Rakesh K. , Kennedy David W. , Palmer James N. 
Published: August 2018

Background Frontal sinus obliteration (FSO) traditionally has represented the final stage in the algorithm for difficult to manage frontal sinus disease. In addition, FSO has been used in selected cases of frontal sinus trauma. However, this procedure has been associated with failure in 5–10% of cases. Advances in surgical instrumentation and image-guided surgical navigation have permitted endoscopic management of these failures. Methods Eleven patients presenting with failure of a previously performed FSO were managed endoscopically with the assistance of image-guided surgical navigation. Results Initial frontal sinus pathology included chronic inflammatory disease in six patients and frontal sinus trauma in two patients. Two patients underwent obliteration after neurosurgical frontal craniotomy and one patient underwent obliteration after curettage of a frontal sinus ossifying fibroma. Frontal sinuses were obliterated with fat in eight cases, bone chips in two cases, and bone cement in one case. The mean time interval to FSO failure was 11.1 years (range, 4 months–35 years). The etiology of failure included mucocele in eight patients, chronic frontal sinusitis in two patients, and Pott's puffy tumor in one patient. All 11 patients were managed endoscopically, of which 3 patients underwent a trans-septal frontal sinusotomy. Two patients required revision endoscopic surgery, but all were patent at last follow-up (mean, 14.8 months). Conclusion Endoscopic management of failed FSO may be performed safely. These approaches are viable alternatives to open revision procedures in the management of failed FSO. (American Journal of Rhinology 18, 279–284, 2004)
Computed Tomography-Generated Templates: A New Approach to Frontal Sinus Osteoplastic Flap Surgery
Authors: Fewins John L. , Otto Pamela M. , Otto Randal A. , Citardi Martin 
Published: August 2018

Background The aim of this study was to present a new technique for frontal sinus template creation used in osteoplastic flap surgery, obviating the need for the traditional 6-ft Caldwell radiograph. Methods Seventeen human cadaver skulls were studied prospectively. Using digital addition algorithms of sequential coronal computed tomography (CT) images of the frontal sinus to create a composite image, an image is printed to 1 cm = 1 cm scale. A frontal sinus template was created using this processed image and compared with a control 6-ft Caldwell radiograph. Results The mean variance between corresponding vertical points on the templates was 0.71 mm (95% confidence interval, 0.56–0.87 mm). The mean variance between horizontal points was 1.11 mm (95% confidence interval, 0.97–1.28 mm). The mean difference in width was 2.46 mm. The plain film templates were always wider than the CT-generated templates. Conclusions The CT-generated frontal sinus templates are virtually identical to the Caldwell radiograph-derived templates. They may obviate the need for additional imaging and minimize the potential errors commonly associated with 6-ft Caldwell templates. (American Journal of Rhinology 18, 285–290, 2004)
Economic Analysis of the Use of Limited Coronal Computed Tomography Scans in the Management of Sinusitis
Authors: Franzese Christine B. , Stringer Scott P. 
Published: August 2018

Background As medical costs increase, less expensive alternatives to standard diagnostic tests are sought to reduce the economic burden placed on society. One alternative is using limited, non-consecutive cut computed tomography (CT) scans for the evaluation of sinonasal disease. This study evaluates the cost-effectiveness of using limited CT scans instead of full sequence CT scans in the diagnosis and management of rhinosinusitis. Methods A Medline search was performed to obtain data for the sensitivity and specificity of limited CT scans, the prevalence of abnormal CT scans, and recommendations on using limited CT scans for operative management. A standard cost-effectiveness analysis, including a sensitivity analysis, was performed using a hypothetical population of patients with sinus complaints who failed prior appropriate medical therapy. Results At baseline, the limited CT scan was found to be less cost-effective than the full CT scan, costing $217.13 more per correct diagnosis. The sensitivity analysis demonstrated that changes in the prevalence of abnormal CT scans and the percentage of surgeons who would operate using a limited scan had the greatest impact on cost, whereas changes in the price of the full CT or limited CT scan had the least effect. Conclusions This study finds the use of limited CT scans to be economically unsound as a method to reduce costs in the defined population. Published literature recommends obtaining a full CT scan before operative management. Basing intervention on limited CT scans increases the possibility of erroneous diagnoses leading to either excessive or inadequate treatment of patients. (American Journal of Rhinology 18, 329–334, 2004)
Numerical Simulation of Airflow Patterns and Air Temperature Distribution during Inspiration in a Nose Model with Septal Perforation
Authors: Pless Daniela , Keck Tilman , Wiesmiller Kerstin M. , Lamche Ralf , Aschoff Andrik J. , Lindemann Joerg 
Published: August 2018

Background The most typical symptoms of patients with nasal septal perforation (SP) are crusting and recurrent nosebleed. The objective of the study was to determine the influence of SP on intranasal temperature profile and airflow patterns during inspiration by means of numerical simulation. Methods Two realistic bilateral models of the human nose with and without SP were reconstructed based on computed tomography (CT). A numerical simulation was performed. The intranasal air temperature distribution and airflow patterns during inspiration were displayed, analyzed, and compared. Results SP causes a highly disturbed airflow in the area of perforation. A spacious vortex within the perforation including various localized vortices was detected. A disturbed intranasal temperature distribution between the right and left nasal cavities developed. Conclusions The numerical simulation demonstrates the interaction between airflow patterns and heating of respiratory air. The disturbed airflow causes reduced air conditioning. This fact may contribute to crusting and recurrent nosebleed.
High Prevalence of Antibiotic Resistance in Isolates from the Middle Meatus of Children and Adults with Acute Rhinosinusitis
Authors: Huang Wei-Hsiung , Fang Sheen-Yie 
Published: August 2018

Background The pathogens in acute rhinosinusitis are similar worldwide. An increase in antibiotic resistance has been shown in a large number of studies in recent years. The prevalence of resistance varies greatly in different countries. This study was performed to determine the endemic prevalence of antibiotic resistance in pathogens of acute rhinosinusitis in Taiwan. Methods Middle meatus discharge was taken for aerobic culture in 133 outpatients with the diagnosis of acute rhinosinusitis. Results One hundred two isolates of pathogens were found, including three major bacteria: Haemophilus influenzae (37.3%), Streptococcus pneumoniae (28.4%), and Moraxella catarrhalis (11.8%). Polymicrobial infections and positive cultures occurred more frequently in pediatric patients, as did recovery of M. catarrhalis infection. An extremely high percentage of resistance to first-line antibiotics was noted, viz., penicillin-nonsusceptible S. pneumoniae (PNSSP) (72.4%), ampicillin-resistant H. influenzae (60.5%), and M. catarrhalis (58.3%). Conclusion The high prevalence of drug resistance is a great threat to public health. Antibiotic use should be more prudent, especially in pediatric patients, who were found to be more susceptible to bacterial rhinosinusitis and multiple pathogenic infection.