Neuroendocrine carcinoma arising from the septum. A very rare nasal tumour.

The case is presented of a 73-year-old male with a history of right-sided nasal obstruction, hyponasal speech and three episodes of recurrent epistaxis. On examination, there was a tumour in the right nasal cavity. Computed tomography showed a mass in the right nasal cavity extending to the right maxillary sinus, ethmoidal cells and right sphenoid sinus. The patient underwent a functional endoscopic removal of the tumour. Biopsy revealed a small cell neuroendocrine carcinoma. This is an extremely rare tumour of the nasal cavity and sinuses. Because of the aggressive behaviour of this tumour, he was also treated with combined chemotherapy and radiation. Ten months later, he remains free of disease.

Clinical outcomes of sinonasal inverted papilloma surgery. A retrospective study of 67 cases.

BACKGROUND: Endoscopic sinus surgery has become popular for the management of sinonasal inverted papillomas (IP). OBJECTIVE: The purpose of this report is to review our 13 years of experience in managing IPs. METHODS: Retrospective chart study. Sixty-seven patients with sinonasal IPs were treated in our department from 1991 to 2004. Seventeen were managed using an endonasal non-endoscopic approach, 39 endoscopically, 8 through external techniques, and the remaining 3 using a combined approach. RESULTS: After 1994, as we gained experience using endoscopic sinus surgery, most cases were treated endoscopically. In only 3 cases, where the tumour attachment site was in the lateral / anterior wall of the maxillary sinus and in the lateral wall of the frontal sinus, could the lesions not be accessed by extended endoscopic techniques, and an appropriate combination with external methods was required. The mean follow up period was 91 (range, 36-146) months. The recurrence rate was 59% using an endonasal non-endoscopic approach, 12.5% using an external incision, and 12.8% using endoscopic techniques. Average time to recurrence was 15 months. CONCLUSION: Our findings suggest that endoscopic sinus surgery for sinonasal IP is a viable approach, with a low rate of recurrence and minor morbidity. Complete tumour resection at the site of attachment, including a surrounding rim of normal mucosa and drilling the underlying bone, is the key to successful treatment when it is combined with the preservation of healthy tissue. Non-endoscopic endonasal surgery is no longer a treatment option because the recurrence rate is too high.

The diagnostic value of earlier and later components of Vestibular Evoked Myogenic Potentials (VEMP) in multiple sclerosis.

AIM OF THE STUDY: To evaluate the ability of VEMP to disclose spatial dissemination of Multiple Sclerosis. MATERIALS AND METHODS: Forty-six MS patients with auditory and/or vestibular symptoms were studied. Patients were divided in two groups. Group 1 included 24 patients with brainstem MRI findings, and Group 2 included 22 patients without MRI findings. VEMP and BAEP have been recorded and assessed. RESULTS: Abnormal p13n23 wave was observed in 50%, while unilateral absence or bilateral delay of the n34p44 in 43% of the patients. The overall diagnostic value considering abnormal cases suggested by both first and second VEMP waves was increased to 71%. Statistically significant differences revealed between patients and controls for p13 latency (p=0.018). The p13n23 was abnormal in 7 patients, although MRI scanning did not reveal brainstem lesions. In 9 out of 18 MS patients suffering from unilateral hearing loss, n34p44 was present in the unaffected ears and absent in the affected side, although p13n23 was normal. CONCLUSION: Abnormal VEMP imply the presence of lesions undetected by MRI neuroimaging, which verifies the diagnostic value of the method. Unilateral absence of n34p44 complex was related with sensorineural hearing loss, supporting the hypothesis that n34p44 is of cochlear origin.

Long-term results of plastipore prostheses in reconstruction of the middle ear ossicular chain.

PURPOSE: To examine the acoustic results over a long period of time, in patients who underwent ossiculoplasty with Plastipore, and to report the percentage of prosthesis extrusion and factors related to the prognosis. PROCEDURES: Forty-two patients, who underwent ossiculoplasty with Plastipore, were studied. Patients were followed up for the next 14 years. The surgical procedures were classified as: tympanoplasty, tympanoplasty with mastoidectomy with canal wall up, and tympanoplasty with mastoidectomy with canal wall down. A successful hearing result was defined as a postoperative air-bone gap (ABG) of 20 dB or less. RESULTS: Successful results were seen in 65% of our patients, 68.8% with a partial ossicular replacement prosthesis (PORP) and a 62.5% success rate with a total ossicular replacement prosthesis (TORP). The mean value for ABG improvement was 25.5 dB. Prosthesis extrusion occurred in 4.7%. CONCLUSIONS: The ossiculoplasty-Plastipore technique leads to good hearing results and a low percentage of prosthesis extrusion in long-term follow-ups.

Expression of substance P, vasoactive intestinal peptide and heat shock protein 70 in nasal mucosal smears of patients with allergic rhinitis: investigation using a liquid-based method.

OBJECTIVE: The aim of this study was to investigate expression of the neuropeptides substance P, vasoactive intestinal peptide and heat shock protein 70 in the nasal mucosa cells of patients with seasonal allergic rhinitis, in order to obtain more information on the pathophysiological and immunological role of these markers in allergic rhinitis. MATERIAL AND METHODS: Nasal epithelium specimens obtained from 42 patients with allergic rhinitis were studied, using Shandon's Papspin liquid-based cytology method. Smears were immunostained with antibodies against substance P, vasoactive intestinal peptide and heat shock protein 70, and the results were correlated with the clinical features of seasonal allergic rhinitis. RESULTS: A positive reaction for substance P, vasoactive intestinal peptide and heat shock protein 70 was observed in 73.8, 66.7 and 69.0 per cent of the allergic rhinitis mucosal smears, respectively. The Pearson chi-square test showed that 40.5 per cent of the immunostained smears had a positive reaction for one or two of the markers studied (i.e. substance P, vasoactive intestinal peptide or heat shock protein 70), and that 47.6 per cent of the smears had a positive reaction for all the markers (p < 0.0001). CONCLUSIONS: We found a high level of expression of substance P and vasoactive intestinal peptide in the nasal mucosa smears of patients suffering from allergic rhinitis. This indicates a role for these neuropeptides in the neuroregulation of immunity and hypersensivity in this disease. Furthermore, expression of heat shock protein 70 may contribute to the development of allergic rhinitis.

Using vestibular evoked myogenic potentials to localise brainstem lesions. A preliminary report.

BACKGROUND: Vestibular Evoked Myogenic Potentials (VEMPs) are saccular responses to acoustic stimuli. They can be recorded from the sternocleidomastoid muscle ipsilaterally to the stimulated ear. Their reflex arc includes the ipsilateral vestibular nuclei. OBJECTIVE: To determine the usefulness of VEMPs in localising brainstem lesions. METHODS: We used VEMPs, Blink Reflex (BR) and Brainstem Auditory Evoked Responses (BAERs) to evaluate six patients presenting with acute ischaemic or haemorrhagic brainstem lesions, or basilar dolichoectasia. RESULTS: MRI in patient one revealed a dorsolateral medullary infarct on the right. VEMP amplitude was reduced ipsilaterally. The R2 BR component was delayed bilaterally upon stimulation of the affected side. Patients two and three had suffered a left lateral lower pontine infarct and a right lateral lower pontine haemorrhage. In patients four and five, MRA revealed dolichoectasia of the basilar artery exerting pressure on the lower lateral pons. VEMP amplitude was reduced ipsilaterally. Patient six had an ischaemic lesion in the right upper lateral pons. The R1, R2i and R2c BR components were delayed ipsilaterally. BAERs waves IV and V were absent on the right. VEMPs were normal. CONCLUSIONS: VEMPs are affected by lesions of the lateral lower pons and upper medulla. Our results suggest that they may be a useful addition in the localisation of such lesions.

Prospective study of a panel of tumor markers as prognostic factors in patients with squamous cell carcinoma of head and neck.

OBJECTIVE: The identification of a reliable circulating tumor marker in squamous cell carcinoma of the head and neck (SCCHN) could assist in diagnosis and monitoring response to therapy. AIM: The aim of this study was to investigate the effectiveness of the serum tumor markers CYFRA 21-1, TPA-M, SCCA, and CEA. STUDY DESIGN: Serum levels of CYFRA 21-1, TPA-M, SCCA, and CEA were measured in 136 patients with a histologically proven SCCHN before and after treatment and in 125 healthy subjects, as controls. We evaluated the sensitivity and specificity of these tumor markers and to correlate their levels with tumor staging, grading, or performance status. RESULTS: The study showed that none of the above markers presented satisfactory specificity and sensitivity in early diagnosis. In comparison with the other markers, TPA-M was the most effective of all markers and indicated a positive correlation with the grade of differentiation and nodal status. A remarkable correlation between high levels of TPA-M and CYFRA 21-1 in advanced stages (III, IV) of cancer has been shown. CONCLUSIONS: All the tumor markers that were studied have significant limitations in the early diagnosis of cancer, but TPA-M and CYFRA 21-1 may have a role in monitoring the success of therapy and follow up of patients with SCCHN.