Clinical medicine insights. Ear, nose and throat最新文献

{"title":"Role of surgery in isolated concha bullosa.","authors":"Hatem Soliman Badran","doi":"10.4137/CMENT.S6769","DOIUrl":"https://doi.org/10.4137/CMENT.S6769","url":null,"abstract":"<p><strong>Objective: </strong>To study the benefit of surgery in different types of isolated concha bullosa.</p><p><strong>Design: </strong>Prospective case series.</p><p><strong>Setting: </strong>Academic Medical Center.</p><p><strong>Patients: </strong>Forty seven symptomatic patients complaining of nasal congestion and block, headache and facial pain having concha bullosa without any other sinonasal finding. Their conchae bullosa were classified as lamellar, bulbous and extensive concha bullosa. They were subjected to endoscopic operation.</p><p><strong>Main outcome measures: </strong>Subjective evaluation of postoperative improvement of sinonasal symptoms and objective pre- and postoperative measurement of total nasal resistance by rhinomanometry.</p><p><strong>Results: </strong>Two patients (25%) of lamellar type showed complete improvement, 5 patients (62.5%) showed partial improvement and 1 patient (12.5%) showed no improvement. Regarding bulbous type, 16 patients (72.72%) showed complete improvement, 6 patients (27.28%) showed partial improvement and no patient (0%) showed no improvement. Regarding extensive type, 15 (88.24%) patients showed complete improvement, 2 patients (11.76%) showed partial improvement and no patient (0%) showed no improvement. The total nasal resistance was 0.25 Pa/cm(3) per second postoperatively compared with 0.37 Pa/cm(3) per second preoperatively in patients having lamellar type; 0.28 Pa/cm(3) per second postoperatively compared with 0.71 Pa/cm(3) per second preoperatively in patients having bulbous type; and 0.27 Pa/cm(3) per second postoperatively compared with 0.67 Pa/cm(3) per second preoperatively in patients having extensive type.</p><p><strong>Conclusions: </strong>With proper patient selection, the operative management is of great value in relieving the sinonasal symptoms in patients having isolated Concha bullosa. This will be more obvious in certain types as bulbous and extensive types especially of large sizes.</p>","PeriodicalId":89906,"journal":{"name":"Clinical medicine insights. Ear, nose and throat","volume":"4 ","pages":"13-9"},"PeriodicalIF":0.0,"publicationDate":"2011-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMENT.S6769","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31824212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of the facial nerve in lateral skull base surgery analytic retrospective study.","authors":"Mohamed A El Shazly,&nbsp;Mahmoud A M Mokbel,&nbsp;Amr A Elbadry,&nbsp;Hatem S Badran","doi":"10.4137/CMENT.S6570","DOIUrl":"https://doi.org/10.4137/CMENT.S6570","url":null,"abstract":"<p><strong>Background: </strong>Surgical approaches to the jugular foramen are often complex and lengthy procedures associated with significant morbidity based on the anatomic and tumor characteristics. In addition to the risk of intra-operative hemorrhage from vascular tumors, lower cranial nerves deficits are frequently increased after intra-operative manipulation. Accordingly, modifications in the surgical techniques have been developed to minimize these risks. Preoperative embolization and intra-operative ligation of the external carotid artery have decreased the intraoperative blood loss. Accurate identification and exposure of the cranial nerves extracranially allows for their preservation during tumor resection. The modification of facial nerve mobilization provides widened infratemporal exposure with less postoperative facial weakness. The ideal approach should enable complete, one stage tumor resection with excellent infratemporal and posterior fossa exposure and would not aggravate or cause neurologic deficit. The aim of this study is to present our experience in handling jugular foramen lesions (mainly glomus jugulare) without the need for anterior facial nerve transposition.</p><p><strong>Methods: </strong>In this series we present our experience in Kasr ElEini University hospital (Cairo-Egypt) in handling 36 patients with jugular foramen lesions over a period of 20 years where the previously mentioned preoperative and operative rules were followed. The clinical status, operative technique and postoperative care and outcome are detailed and analyzed in relation to the outcome.</p><p><strong>Results: </strong>Complete cure without complications was achieved in four cases of congenital cholesteatoma and four cases with class B glomus. In advanced cases of glomus jugulare (28 patients) (C and D stages) complete cure was achieved in 21 of them (75%). The operative complications were also related to this group of 28 patients, in the form of facial paralysis in 20 of them (55.6%) and symptomatic vagal paralysis in 18 of them (50%).</p><p><strong>Conclusions: </strong>Total anterior rerouting of the facial nerve carries a high risk of facial paralysis. So it should be reserved for cases where the lesion extends beyond the vertical ICA. Otherwise, for less extensive lesions and less aggressive pathologies, less aggressive approaches could be adopted with less hazards.</p>","PeriodicalId":89906,"journal":{"name":"Clinical medicine insights. Ear, nose and throat","volume":"4 ","pages":"21-30"},"PeriodicalIF":0.0,"publicationDate":"2011-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMENT.S6570","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31824213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nasopharyngeal cancer in Sudan: epidemiology, clinical and histological characteristics.","authors":"Nazik E Abdullah,&nbsp;Ameera A M Adam,&nbsp;Eman H Khalifa,&nbsp;Lamyaa A M El Hassan,&nbsp;M E Ibrahim,&nbsp;K M Hamad,&nbsp;A M El Hassan","doi":"10.4137/CMENT.S5825","DOIUrl":"https://doi.org/10.4137/CMENT.S5825","url":null,"abstract":"<p><strong>Objectives: </strong>To study the epidemiology, clinical features, staging, etiology and pathology of nasopharyngeal cancer in Sudan.</p><p><strong>Study design: </strong>This is a retrospective study.</p><p><strong>Setting: </strong>Ear, Nose and Throat Department Khartoum Teaching Hospital, Khartoum City, Sudan.</p><p><strong>Subjects and methods: </strong>Patients suspected to have nasopharyngeal cancer were assessed during the period March 2004 to May 2010. Data from confirmed cases was obtained; it included clinical and epidemiological information.</p><p><strong>Results: </strong>Three hundred and eighty five cases were studied. Bimodal age distribution of the disease was noted with two peaks, one at 15-19 years and one at 50-54 years. The male to female ratio was 2.6:1 and a distinct geographical distribution of the disease was noted, with clustering of cases in the towns of Dilling, Kadogli and the surrounding rural area of the Nuba Mountains. These areas in the Western States were reported to be of high background radiation due to naturally produced radioactive uranium. The Nuba tribe headed the list among other tribes, demonstrating a clear ethnic predilection. Sixty-eight cases presented at stage IV. There was a predominance of Type II (15.58%) and Type III (65.97%). Patients were treated by neoadjuvant chemoradiotherapy.</p><p><strong>Conclusions: </strong>NPC is an important form of cancer in Sudan. Some tribes are significantly more affected than others. Patients present with advanced disease. Environmental and genetic factors need further studies. Screening at risk populations that aim at early diagnosis and management of patients is recommended.</p>","PeriodicalId":89906,"journal":{"name":"Clinical medicine insights. Ear, nose and throat","volume":"4 ","pages":"5-11"},"PeriodicalIF":0.0,"publicationDate":"2011-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMENT.S5825","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31824211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alternative agents to prevent fogging in head and neck endoscopy.","authors":"Patorn Piromchai,&nbsp;Pornthep Kasemsiri,&nbsp;Sanguansak Thanaviratananich","doi":"10.4137/CMENT.S6597","DOIUrl":"https://doi.org/10.4137/CMENT.S6597","url":null,"abstract":"<p><strong>Background: </strong>The essential factor for diagnosis and treatment of diseases in head and neck endoscopy is the visibility of the image. An anti-fogging agent can reduce this problem by minimizing surface tension to prevent the condensation of water in the form of small droplets on a surface. There is no report on the use of hibiscrub(®) or baby shampoo to reduce fogging in the literature. The objective of this study was to compare the efficacy between commercial anti-fogging agent, hibiscrub(®) and baby shampoo to reduce fogging for the use in head and neck endoscopy.</p><p><strong>Methods: </strong>The study was conducted at the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University in August 2010. Commercial anti-fogging agent, baby shampoo and hibiscrub(®) were applied on rigid endoscope lens before putting them into a mist generator. The images were taken at baseline, 15 seconds, 30 seconds and 1 minute. The images' identifiers were removed before they were sent to two evaluators. A visual analogue scale (VAS) was used to rate the image quality from 0 to 10.</p><p><strong>Results: </strong>The difference in mean VAS score between anti-fogging agent, baby shampoo and hibiscrub(®) versus no agent were 5.46, 4.45 and 2.1 respectively. The commercial anti-fogging agent and baby shampoo had most protective benefit and performed significantly better than no agent (P = 0.05).</p><p><strong>Conclusions: </strong>Baby shampoo is an effective agent to prevent fogging during head and neck endoscopy and compares favourably with commercial anti-fogging agent.</p>","PeriodicalId":89906,"journal":{"name":"Clinical medicine insights. Ear, nose and throat","volume":"4 ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2011-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMENT.S6597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31824209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Article Commentary: Fas and Cancer","authors":"K. A. Abou-Elhamd","doi":"10.4137/CMENT.S3147","DOIUrl":"https://doi.org/10.4137/CMENT.S3147","url":null,"abstract":"Apoptosis is an active process of programmed cell death. Fas is a cell-surface protein which is expressed on activated lymphocytes and known as CD95, TNFRSF6 or APO-1. Fas-L is ligand of Fas and known as CD95 LG or TNFSF6. Apoptosis or cell death is a result of binding of Fas-L to Fas which is expressed on the surfaces of these cells. Cancer cells escape this binding by overexpression of Fas-L or down expression of Fas. Fas and Fas-L exist in membrane bound and soluble forms. The serum level of sFas and sFas-L can be evaluated by immunostaining, immunohistochemical methods, immunofluorescence, flow cytometry and Western blotting. Head and neck squamous cell carcinoma diagnosis, staging and prognosis can be evaluated early and accurately by sFas and sFas-L expression levels detection.","PeriodicalId":89906,"journal":{"name":"Clinical medicine insights. Ear, nose and throat","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMENT.S3147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70695217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Co-phenylcaine Spray or Lidocaine/Epinephrine Nasal Packing for Flexible Laryngoscopy","authors":"R. P. D. de Freitas, B. Hanna, S. Hall","doi":"10.4137/CMENT.S4533","DOIUrl":"https://doi.org/10.4137/CMENT.S4533","url":null,"abstract":"Background Nasal preparation prior to flexible laryngoscopy is a common ENT practice. Co-phenylcaine is increasingly used because it is safe and has both anaesthetic and vasoconstrictive properties. Lidocaine 4% and epinephrine 1:1000 nasal packing is another method used in our department. Methods A prospective case series was performed on eighty-one patients requiring flexible laryngoscopy. Patients were enrolled into either a co-phenylcaine or a lidocaine/epinephrine packing group. Visual analogue scales (VAS) were used to record unpleasantness of nasal preparation and flexible laryngoscopy. Decongestion and ease of endoscope passage were recorded by the doctors. Results Bad taste was statistically significantly worse when using cophenylcaine for nasal preparation (P = 0.001). However, there was no statistically significant difference in overall unpleasantness from nasal preparation or from subsequent flexible laryngoscopy between the two groups. There was no statistically significant difference in degree of decongestion or ease of endoscope passage between the two groups. Conclusion There is no statistically significant advantage of using cophenylcaine spray over non-proprietary lidocaine 4% and epinephrine 1:1000 nasal packing. However cost and bad taste is less with nasal packing.","PeriodicalId":89906,"journal":{"name":"Clinical medicine insights. Ear, nose and throat","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMENT.S4533","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70696028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nanobacteria: An Infectious Cause for Salivary Stone Formation and Recurrence","authors":"A. Badry, M. Mokbel, Ismail El Mofty, A. Mohamed","doi":"10.4137/CMENT.S5147","DOIUrl":"https://doi.org/10.4137/CMENT.S5147","url":null,"abstract":"Nanobacteria (NB) contribute to pathological calcification in the human and animal body. It has been isolated from salivary stones and suggested that it may act as a nucleus for the initiation of these stones. In the present study, we examined its role in the recurrent salivary gland stones using immunodetection with NB-specific monoclonal antibodies and scanning electron microscopy (SEM) hoping to provide a method for preventing the recurrence of these stones in the patient that has suffered from salivary stones. Our study comprised 30 patients with recurrent salivary gland stones (group I) and 30 patients with salivary gland stones for the first time (group II), in addition to 30 normal controls (group III). We could detect 100–500 nm nanoparticles in 24/30 (80%) cases in group I with significant difference <0.05 and <0.01 when compared with group II and group III in which they were detected in 19/30 (63.3%) and 6/30 (20%) respectively. Also there was a significant difference <0.05 between group II and group III. We proposed that salivary stone formation is a nanobacterial disease initiated by bacterial infection. This bacteria may play an important role in the recurrence of salivary stone. So the use of calcium chelator, ethylene diamine tetra acetic acid (EDTA), before or in combination with the suitable antibiotic that is given in an amount effective to inhibit or prevent the growth and development of nanobacteria may eradicate these stones and prevent their recurrence.","PeriodicalId":89906,"journal":{"name":"Clinical medicine insights. Ear, nose and throat","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMENT.S5147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70695765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of sFas in the Immune Escape Mechanism and Progression of Cancer Larynx","authors":"A. Badry, Ismail Elmofty, A. Helmy","doi":"10.4137/CMENT.S2565","DOIUrl":"https://doi.org/10.4137/CMENT.S2565","url":null,"abstract":"This work assess serum levels of soluble Fas form (sFas) in patients with different stages of laryngeal squamous cell carcinoma(LSCC) to investigate its prognostic significance. We correlate its levels with the morphological changes of peripheral blood cells via buffy coat examinatin. The study population included 70 patients clinically diagnosed and pathohistologically confirmed LSCC in addition to 20 healthy controls. According to TNM classification 33(47.1%) patients were in stage I (group I) and 24(34.3%) in stage II (group II), 13(18.5%) in stage III (group III). The results revealed that the mean serum level of sFas (pg/ml) in the control group was 51.2, in group I was 66.33, in group II was 81.33 and in group III was 112.45. Statistical analysis of the mean of sFas by ELISA test in the patients' groups in comparison to the control revealed a significant increase of both group II and III in comparison to the control group (P < 0.01) but there was no significant difference (P > 0.05) between group I in comparison to either the control or group II. There was a significant difference (P < 0.05) between group I in comparison to group III. LM examination revealed massive extent of the apoptotic cells in group III when compared to both group I and group II. EM examination of the buffy coat revealed apoptotic changes, mainly in the peripheral blood mononuclear cells (PBMNCs), represented by surface membrane ruffles and blebs with clumped nuclear chromatin and vacuolated cytoplasm. In conclusion, this study may help us to better understand one of the escape mechanisms in cancer larynx. This mechanism is represented by the significant increase in both the serum level of sFas and the morphological apoptotic changes that detected in PBMNCs. Soluble Fas may contribute to the progression of laryngeal cancer. It can be used as an attractive target for anticancer therapy and may be considered as a marker of disease progression and poor prognosis in laryngeal cancer.","PeriodicalId":89906,"journal":{"name":"Clinical medicine insights. Ear, nose and throat","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMENT.S2565","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70695180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemangioma of the Thyroid","authors":"A. Sakai, I. Sugitani, N. Yamamoto, K. Kawabata","doi":"10.4137/CMENT.S3170","DOIUrl":"https://doi.org/10.4137/CMENT.S3170","url":null,"abstract":"Introduction Thyroid hemangioma is very rare, and only a few cases have previously been reported. We encountered a patient with thyroid hemangioma diagnosed after surgery. Case Report A 71-year-old woman visited our hospital with a mass in the left thyroid region. A 5-cm, elastic mass of the thyroid was palpable in the left anterior neck. On cytology by fine-needle aspiration (FNA), the specimen mainly contained blood components without apparent atypical cells. A tumor with abundant blood flow was suspected based on Doppler ultrasonography. Adenomatous goiter was suspected, and subtotal thyroidectomy was performed. A blood clot was present in the tumor, and hemangioma was diagnosed on postoperative histopathological examination. Discussion Preoperative diagnosis of thyroid hemangioma is difficult. However, Doppler ultrasonography and FNA are useful for diagnosis. A differential diagnosis of hemangioma should be considered when blood flow is abundant and only blood components are collected.","PeriodicalId":89906,"journal":{"name":"Clinical medicine insights. Ear, nose and throat","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMENT.S3170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70695400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers for Cancers of the Head and Neck","authors":"V. Lutzky, D. Moss, D. Chin, W. Coman, P. Parsons, G. Boyle","doi":"10.4137/CMENT.S1051","DOIUrl":"https://doi.org/10.4137/CMENT.S1051","url":null,"abstract":"Head and neck cancer is a broad term used to describe malignancies that arise in the nasal and oral cavities, pharynx and larynx, as well as the paranasal sinuses. Head and neck squamous cell carcinoma (HNSCC) affects the squamous epithelium of the oral cavity, tongue and oropharynx, excluding the nasopharynx. Recent advances in molecular technology, including gene expression and proteomic profiling appear to offer the potential for the development of specific biomarkers including diagnostic tools which may act as an aid to guide therapy for this malignancy. The other human head and neck cancer included in this review, nasopharyngeal carcinoma (NPC) is a malignancy derived from the undifferentiated epithelium of the nasopharyngeal cavity, and is considered here as a separate entity because its strong association with Epstein-Barr virus (EBV) presents the opportunity for the development of virus related and unrelated biomarkers. In particular, IgA antibodies to EBV and high levels of EBV DNA in serum samples of NPC patients have been recorded. This review aims to summarize some current and also potential new biomarkers that could be used for screening, diagnosis, monitoring and prognostic prediction for cancers of the head and neck, including NPC and HNSCC.","PeriodicalId":89906,"journal":{"name":"Clinical medicine insights. Ear, nose and throat","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMENT.S1051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70695468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}