Apoptotic and proliferative status in HPV (+) and HPV (-) inverted papilloma patients. Correlation with local recurrence and clinicopathological variables.

Inverted papilloma (IP) is a rare sinonasal benign lesion characterized by aggressive biological behavior. Our aim was to evaluate the expression of various proliferation and apoptotic markers and the presence of HPV genotypes in paraffin sections gathered from surgically treated IP patients. Immunohistochemistry for PCNA, bax, cytochrome c and caspase-8 and flow cytometry for the detection of apoptosis, necrosis and ki67 expression were performed. The identification of various HPV subtypes was achieved by nested PCR amplification. Nasal polyps (NP) and specimens from normal nasal epithelium (NE) were used as controls. PCNA was more frequently expressed in IP compared to NE (p=0.04) and caspase-8 and bax staining were less frequently observed in IP compared to NP (p=0.004 and p=0.01 respectively) and NE (p=0.003 and p=0.01, respectively). IP and NP presented significantly higher Ki67 flow cytometry values compared to NE (p<0.001 and p=0.02 respectively). Cytochrome c was more frequently expressed in IP specimens with more prominent inflammation (p=0.02). A low HPV DNA detection rate was observed. Neither HPV status nor any of the apoptotic or proliferative markers studied was associated with the patients' clinicopathological characteristics. Increased Ki67 appeared to correlate with disease recurrence (p=0.01). Increased PCNA and Ki67 and decreased bax and caspase-8 expression indicate that cell proliferation is increased while apoptosis is inhibited in IP, explaining its biological behavior.

Comparison of ultrasound turbinate reduction, radiofrequency tissue ablation and submucosal cauterization in inferior turbinate hypertrophy.

Chronic nasal obstruction owed to chronic hypertrophic rhinitis is a common cause of nasal airway obstruction. In cases unresponsive to conservative treatment, various surgical techniques are commonly performed, but the issue of the optimal surgical procedure is still controversial. The objective of the present study was to evaluate the effectiveness and safety of ultrasound treatment of the hypertrophied inferior turbinates, which is a technique recently applied in rhinologic surgery. We aimed, also, to compare this method with the radiofrequency cold coblation turbinate reduction and the traditional submucosal monopolar inferior turbinate cauterization. We studied prospectively 60 patients with chronic hypertrophic rhinitis of nonallergic etiology, who underwent different surgical methods of turbinate reduction, divided into two groups: (1) in 30 patients, inferior turbinate volume reduction using ultrasound procedure on the left side and monopolar diathermy on the right was performed; (2) in 30 patients, radiofrequency coblation technique on the left side and ultrasound turbinate reduction on the right side was undertaken. Subjective evaluation of nasal obstruction and pain was performed using visual analog scales and objective evaluation of the surgical outcome was obtained using active anterior rhinomanometry and acoustic rhinometry. Examinations were performed preoperatively, and 1, 3 and 6 months after surgery. Both subjective and objective evaluation showed significant postoperative improvement in all cases. The best results were obtained with the ultrasound procedure, and second with the radiofrequency technique. The least improvement was observed in the electrocautery group, although its results did not differ significantly from the radiofrequency group. It may be, thus, concluded that ultrasound turbinate reduction is an effective and safe procedure for the management of chronic hypertrophic rhinitis, in patients failing to respond to medical treatment. Using this method, better results were obtained in decreasing subjective symptoms and nasal obstruction, in comparison with radiofrequency and electrocautery.

Distortion product otoacoustic emissions in an industrial setting.

Distortion product otoacoustic emissions (DPOAEs) is an objective sensitive test of cochlear function. The aim of this study was the evaluation of noise-induced hearing loss in a group of industrial workers, using this method in conjunction with standard puretone audiometry (PTA). One hundred and five subjects (210 ears) were included in the study. PTA, tympanometry, and DPOAEs were performed. Results were analyzed using a mixed analysis of variance model, and compared with the data of 34 normal persons of similar age and sex. We found statistically significant lower DPOAE levels in the noise-exposed group than in the control group. Additionally, the effect of frequency was significant, indicating that amplitude varied across frequency, with lower responses observed at 4 and 6 kHz, and maximum response found at 2 kHz. PTA showed a statistically significant effect of Group, owed to elevated puretone thresholds in the noise-exposed subjects, but a Frequency main effect was not found, although the interaction between Frequency and Group was statistically significant, as well as the interaction between Frequency and Ear. A main effect for Ear was found only in puretone thresholds, due to better thresholds in the left ears of the subjects, and not in DPOAE measurements. DPOAE levels were selectively affected at the higher frequencies, whereas puretone thresholds were affected at all frequencies. Direct comparison of the number of significantly affected ears between the two methods at 1, 2, and 4 kHz showed statistically significant differences at all comparisons, with more ears affected in PTA in comparison with DPOAEs at 4 kHz, whereas more ears were affected in DPOAEs at the lower frequencies (1 and 2 kHz). Therefore, it may be concluded that DPOAEs and PTA are both sensitive methods in detecting noise-induced hearing loss, with DPOAEs tending to be more sensitive at lower frequencies.

Rhinology resources on the internet: an update.

AIM: There has been a significant increase in the number of clinically useful biomedical resources available through the Internet over the last few years. The aim of this article is to present an updated list of all the worldwide web sites of rhinology. METHODS: All rhinologic links, which appear on the web site of the journal "Rhinology" were accessed and updated. Non-responding links were discarded and a new extensive survey of all rhinologic sites on the Internet was performed using on-line available search engines. All sites were accessed more than once at different times and their uniform resource locator (URL) address was recorded. RESULTS: The URL addresses of all rhinologic sites on the Internet appear in categories. Main categories include endoscopy and operative techniques, allergy, olfaction, rhinology clinics and research centers, organizations and societies, scientific journals, discussion groups, news and medical conferences, collective otolaryngology resources, and miscellaneous other sites of interest to rhinologists. CONCLUSIONS: This paper summarizes several types of resources available to rhinologists on the Internet. A complete universal list was composed, in which links to almost all interesting rhinologic links were included.

Mucosal changes in chronic hypertrophic rhinitis after surgical turbinate reduction.

Chronic nasal obstruction owed to chronic hypertrophic rhinitis is one of the most common problems encountered in rhinology. Various forms of conservative therapy have been used, but these are often ineffective and surgical reduction techniques have been successfully applied. However, the issue of postoperative histological changes in the nasal mucosa has not been adequately addressed. The aim of the present study was to comparatively evaluate the effect of the methods of submucosal monopolar diathermy, radiofrequency coblation and ultrasounds on the nasal mucosa. Sixty patients with chronic hypertrophic rhinitis of nonallergic etiology underwent different surgical methods of turbinate reduction, divided into two groups: (1) 30 patients underwent tissue volume reduction of the inferior nasal turbinates using ultrasound procedure on the left side and monopolar diathermy on the right; (2) 30 patients underwent radiofrequency coblation technique on the left side and ultrasound reduction on the right. We studied 20 preoperative specimens of the inferior turbinate mucosa taken randomly from both groups of patients, 5 from each side of each group. Normal nasal mucosal specimens taken from ten healthy persons were used as controls. Specimens of the inferior turbinate were taken after 1, 3, and 6 months after surgery, from the same patients. All specimens were examined by electron microscopy. Preoperative observation revealed degeneration of epithelial cells, loss of cilia, disruption of intercellular connections, edema, nasal mucus overproduction and inflammatory infiltration in chorium. Postoperative observations revealed decrease of intercellular edema, reduction of mucus, overproduction of collagen and degeneration of the epithelium to flattened stratified. Only specimens after use of ultrasounds showed islands with normally organized epithelium of columnar ciliated cells. It may be concluded that epithelial changes owed to chronic hypertrophic rhinitis do not significantly improve postoperatively after turbinate tissue volume reduction. Only in several cases operated with ultrasounds, regeneration of epithelium occurs, resulting to anatomical and functional restoration of the nasal physiology.