Laryngopharyngeal reflux in chronic rhinosinusitis patients and the role of endoscopic sinus surgery.

OBJECTIVES: Latest literature proposes laryngopharyngeal reflux (LPR) as the underlying contributory factor for chronic inflammation in both upper and lower airways. In this study, we investigated LPR symptoms and signs of CRS patients and the various factors on their LPR symptoms and signs. We also evaluated the effect of the LPR symptoms and signs of CRS patients after endoscopic sinus surgery (ESS). METHODS: We performed a retrospective analysis from 91 patients who underwent primary ESS. They were assessed for LPR symptoms with Reflux Symptom Index (RSI) and Reflux Finding Scores (RFS) before ESS. Sino-Nasal Outcome Test (SNOT)-22, Lund-Mackay (LM) scoring system, and Lund-Kennedy (LK) scoring system were evaluated for CRS severity. They had to fulfill SNOT-22, RSI, and RFS at 6 months after surgery. RESULTS: Nasal polyps, smoking, asthma, allergy, LM scores and LK scores didn't have significant correlations with preoperative RSI and RFS (P > .05 for all). RSI had significant correlations with SNOT-22 preoperatively and postoperatively (P < .05 for all). RFS had a significant correlation with postoperative SNOT-22 (P = 0.034). RSI and RFS decreased significantly more after ESS (P < 0.001 for both). Smoking had a significant effect on the postoperative RFS (P = 0.003). Non-smoker showed significantly lower scores of postoperative RFS (P = .0.003). CONCLUSION: Our study suggests that subjective CRS symptoms were related with subjective LPR symptoms and ESS was effective in reducing signs and symptoms of LPR in CRS patients. Especially, smoking was associated with less improvement of laryngoscopic findings after ESS.

Effects of azathioprine and its metabolites on inflammatory cytokines in human nasal polyp organ cultures.

BACKGROUND: Oral steroids are recommended for the treatment of nasal polyps (NPs), but prolonged use is avoided because of side effects. Topical steroids can also control NPs without significant complications; however, the response to this is partially successful, and additional therapies are needed to treat glucocorticoid-resistant NPs. Azathioprine (AZA) and its first metabolite 6-mercaptopurine (6-MP) are important immunosuppressants used for the therapy of various diseases. The aim of this study was to investigate the effects of AZA and 6-MP on inflammatory cytokines in organ-cultured NPs. METHODS: NP explants were cultured using an air-liquid interface method. Cultures were maintained in the absence and presence of steroid, AZA, and 6-MP for 72 hours. Elaboration of cytokines tumor necrosis factor alpha (TNF-α), interleukin (IL)-2, IL-4, IL-5, and IL-13 into the supernatant was quantitated using the enzyme-linked immunosorbent assay (ELISA). The messenger RNA (mRNA) expression levels of TNF-α, IL-2, IL-4, IL-5, and IL-13 in cultured mucosa were measured using real-time polymerase chain reaction. Hematoxylin and eosin staining of cultured mucosa was performed to observe inflammatory cells. Immunohistochemistry was done to evaluate the distribution pattern of inflammatory cytokines in NP explants. RESULTS: On histologic examination, less inflammatory cell infiltration was found in NPs treated by steroid, AZA, and 6-MP than in control, but there was no statistical significance (p = 0.218). On immunohistochemistry, IL-13 showed a steady falling tendency in submucosal glands by steroid, AZA, and 6-MP. Expression of TNF-α, IL-2, IL-4, IL-5, and IL-13 mRNA in the NPs treated by steroid, AZA, and 6-MP were significantly lower than those of the control (p < 0.001 for all). By ELISA, IL-2 and IL-13 were significantly lower with topical steroid, AZA, and 6-MP treatment (p = 0.012 and p < 0.001). CONCLUSION: Topical AZT decreases inflammatory cytokines on human NP explants and this could have future therapeutic implications for NPs.

Comparison of Clinical Presentation and Surgical Outcomes Between Recurrent Acute Rhinosinusitis and Chronic Rhinosinusitis.

INTRODUCTION: The authors assessed clinical presentations and anatomic variants among patients with recurrent acute rhinosinusitis (RARS), chronic rhinosinusitis (CRS) without nasal polyps (CRSsNP), and CRS with nasal polyps (CRSwNP). Additionally, differences in the postoperative improvement of each category were evaluated. METHODS: The authors performed an analysis of 304 patients who underwent endoscopic sinus surgery. They were divided into groups with RARS, CRSsNP, and CRSwNP. Patients had to complete the Sino-Nasal Outcome Test (SNOT-20) on surgery 1 day before and 6 months after surgery. Patient demographics and comorbidities were reviewed. We reviewed all patients' computed tomographic findings to analyze anatomic variants. RESULTS: No significant differences were found among the average preoperative SNOT-20 scores of the 3 groups. Patients with RARS were significantly more likely to show agger nasi cells, Haller cells, and septal deviation on computed tomography. Those with CRSwNP had significantly smaller mean infundibular widths. All groups showed significantly improved SNOT-20 scores postoperatively. CONCLUSION: The different anatomic variants found among patients with RARS, CRSsNP, and CRSwNP can facilitate surgical prognostic evaluation.

Effect of Fentanyl Nasal Packing Treatment on Patients With Acute Postoperative Pain After Nasal Operation: A Randomized Double-Blind Controlled Trial.

PURPOSE: Nasal packing is an option for bleeding control after endoscopic sinus surgery and septoplasty. Although new packing materials have been developed, patients still suffer from pain and require additional analgesics treatments. In this study, a prospective, randomized, and double-blind controlled trial was designed to evaluate the effect of fentanyl-soaked packing on pain after endoscopic sinus surgery and septoplasty. METHODS: One hundred fifty-two patients who underwent nasal surgeries due to chronic rhinosinusitis or nasal septal deviation were enrolled in this study. At the end of operation, 50 mcg fentanyl-soaked biodegradable synthetic polyurethane foams packing Nasopore or Merocel were applied to a group of 79 patients, and saline-soaked ones were applied to another group of 73 patients. To evaluate the influence of fentanyl on postoperative nasal pain, patients' conditions were assessed via means of Numeric Rating Scale, patient satisfaction, and Ramsay Sedation Scale. In addition, symptoms of headache or sore throat and any signs of cardiopulmonary-relevant indicators were monitored. RESULTS: The fentanyl group had significantly decreased Numeric Rating Scale and increased patient satisfaction in every operation type for the majority of postoperative time periods ( P < .05) with reduced postoperative headache and sore throat compared to the control group. The fentanyl group showed a higher score on Ramsay Sedation Scale than the control group ( P < .05 in group including endoscopic sinus surgery). There were no significant differences in cardiopulmonary-relevant indicators between the 2 groups ( P > .05). CONCLUSION: Fentanyl group showed significantly reduced postoperative pain without serious adverse effects. We suggest that topical fentanyl application to nasal packs can be a useful method to reduce pain during the early postoperative period after endoscopic sinus surgery and septoplasty.

Is Facial or Head Pain Related to the Location of Lesions on Computed Tomography in Chronic Rhinosinusitis?

BACKGROUND: Facial or head pain is not an infrequent symptom among patients diagnosed with chronic rhinosinusitis (CRS), but few reports have investigated the pain in CRS, including the relationship between pain and sites of CRS. The aim of this study was to investigate whether pain is related to the location of lesions on computed tomography (CT) in CRS. METHODS: We analyzed 203 patients who underwent endoscopic sinus surgery (ESS) for 2 years. Patients were assessed using the questionnaires on pain, provided 1 day prior to the operation and 6 months post operation. Sites of CRS were evaluated using CT. We analyzed whether the degree of inflammation in each sinus had an effect on the location of pain. RESULTS: Seventy-eight patients (38.4%) had preoperative facial or head pain. There was no difference in the sinus inflammation scores in CT findings, based on the presence of pain. Pain was most commonly located in the periorbital area, followed by the frontal, vertex, occipital, and facial areas. No significant correlation was found between the sinuses and the location of pain. CONCLUSIONS: This study indicates that in CRS patients, several sites of pain are involved, particularly in the periorbital area; these sites were not found to be related to the location of CRS.

A Case of Aggravated Medial Orbital Wall Fracture After Reduction of Orbital Floor Fracture.

Concomitant fractures of the inferior and medial orbital wall can cause more severe orbital symptoms and lead to incomplete reduction postoperatively. This report presents the case of a 17-year-old boy, presenting with persistent diplopia and enophthalmos after floor reduction for concomitant fractures. At the time of the fracture, surgery was performed for only the orbital floor by a plastic surgeon, because the medial wall fracture was minimal. However, he presented with persistent orbital symptoms after surgery. An aggravated medial wall fracture was discovered via computed tomography (CT) examination. It was treated with a minimal-invasive method using an endoscopic approach.

Comparative Study for Efficacy and Safety of Adenoidectomy according to the Surgical Method: A Prospective Multicenter Study.

BACKGROUND/OBJECTIVE: There have been several operative techniques for adenoidectomy and their efficacy and morbidity are different according to the technique. This prospective multicenter study was aimed to compare the efficacy and morbidity of coblation adenoidectomy (CA) with those of power-assisted adenoidectomy. STUDY DESIGN: Prospective multi-institutional study. METHODS: Children who underwent CA, power-assisted adenoidectomy with cauterization (PAA+C) or without cauterization (PAA-C) due to adenoid hypertrophy were enrolled from 13 hospitals between July 2013 and June 2014. Mean operation time, degree of intraoperative bleeding and postoperative bleeding rate were evaluated. RESULTS: A total of 388 children (mean age ± standard deviation = 6.6 ± 2.5 years; 245 males and 143 females) were included. According to the adenoidectomy technique, the children were classified into 3 groups: (1) CA (n = 116); (2) PAA+C (n = 153); and (3) PAA-C (n = 119). Significant differences were not found in age and sex among three groups. In the CA group, mean operation time was significantly shorter (P < 0.001) and degree of intraoperative bleeding was significantly less (P < 0.001) compared to PAA+C or PAA-C group. Delayed postoperative bleeding rate of PAA-C group was significantly higher than that of CA or PAA+C group (P = 0.016). CONCLUSIONS: This prospective multicenter study showed that CA was superior to PAA in terms of mean operation time and degree of intraoperative bleeding.

Vegetable or pulse granuloma in the nasal cavity.

Vegetable granuloma or pulse granuloma results from the implantation of food particles of vegetable origin. Pulse granulomas have mainly been reported in association with lung aspirations, the oral cavity with a history of oral procedures and less frequently in gastrointestinal tracks. We report a 31-year-old woman who presented with right nasal obstruction and was found to have a firm mass in the right nasal cavity. Paranasal sinus computerized tomography scans identified a calcified ring lesion in her right nasal cavity. Endoscopic sinus surgery was performed, and pathology examination revealed a lesion consistent with a pulse granuloma that contains starch granules with cellulose envelopes appearing as hyaline rings surrounded by inflammation cells and concentrically arranged delicate connective tissue. Pulse granuloma is a well described entity with distinct histopathology. However, pulse granulomas are rare, and especially extraoral pulse granulomas are extremely rare. We found that pulse granuloma can be occurred in the nasal cavity through regurgitation.

Expression of matrix metalloproteinase 2 and 9 and tissue inhibitor of metalloproteinase 1 in nonrecurrent vs recurrent nasal polyps.

BACKGROUND: Matrix metalloproteinases (MMPs) 2 and 9 are a group of Zn2+-dependent endopeptidases to remodel the extracellular matrix. The association of these 2 endopeptidases with the development of morphologic changes in nasal polyps was previously described. OBJECTIVE: To determine whether MMP-2, MMP-9, and tissue inhibitor of MMP-1 (TIMP-1) play a role in the recurrence of nasal polyps. METHODS: To compare MMP-2, MMP-9, and TIMP-1 expression in recurrent vs nonrecurrent polyps, nasal polyps (NPs) and recurrent nasal polyps (RNPs) were obtained from 15 NP patients with chronic rhinosinusitis (CRS) undergoing endoscopic sinus surgery (ESS) and 15 RNP patients with CRS undergoing revision ESS. Fifteen specimens of inferior turbinate mucosa from patients undergoing nasal septal surgery were used as control. Through real-time polymerase chain reaction and immunohistochemistry, MMP-2, MMP-9, and TIMP-1 expressions were measured among controls, NP patients, and RNP patients. RESULTS: Expression of MMP-9 messenger RNA in the NP patients was significantly higher than in the controls. In addition, expression of MMP-9 messenger RNA in the RNP patents was significantly increased compared with NP patients. With immunohistochemistry, a more increased expression of MMP-9 was observed in NP patients than controls. Expression of MMP-9 in RNP patients was also significantly high compared with NP patients, particularly in stroma. CONCLUSION: Expression of MMP-9 is increased in NP patients, and it is so more in the mucosa of RNP patients. Increased expression of MMP-9 is particularly found in the stoma of RNP patients, and it may contribute to the recurrence of NP.

The effectiveness of lumbar drainage in the conservative and surgical treatment of traumatic cerebrospinal fluid rhinorrhea.

CONCLUSIONS: We found no differences in clinicopathologic factors and post-treatment effects between patients who did and did not receive lumbar drains (LDs) in the management of cerebrospinal fluid (CSF) rhinorrhea. Care should be taken in using LDs, after considering their effectiveness and complications, although routine use of an LD is not indicated in the management of traumatic CSF rhinorrhea. OBJECTIVES: We assessed the role and effectiveness of LDs in patients managed conservatively and surgically. METHODS: Of 117 patients treated for CSF rhinorrhea, 61 were managed conservatively and 56 were initially managed surgically. We compared the clinicopathologic features and factors related to treatment outcome between patients who did and did not receive LDs. RESULTS: Of 61 conservatively managed patients, 32 were managed without and 29 with LDs. There were no between-group differences in any clinicopathologic factors, recurrence rate, or incidence of meningitis during/after treatment, but duration of hospitalization differed significantly (15.3 vs 23.2 days, p = 0.03). Of 56 surgically managed patients, 24 were managed without and 32 with postoperative LDs. Except for age, there were no between-group differences in clinicopathologic factors. In terms of treatment outcome-related factors, there was no significant difference in recurrence rate, incidence of meningitis, or duration of hospitalization.

Nasal skin thickness measured using computed tomography and its effect on tip surgery outcomes.

OBJECTIVE: Skin thickness can be a major factor affecting rhinoplasty outcomes. However, few studies have examined the impact of nasal skin thickness on rhinoplasty aesthetic results. The aim of this study is to determine the effect of nasal skin thickness on the tip surgery outcome objectively. STUDY DESIGN: Case series with chart review. SETTING: Academic tertiary care medical center. SUBJECTS AND METHODS: The study involved 77 patients who were evaluated using preoperative computed tomography scans and underwent rhinoplasty including tip surgery. Surgical outcomes were classified as excellent, good, or poor. Nasal skin thickness was measured at nasion, rhinion, nasal tip, and columella using computed tomography scans and was analyzed according to surgical outcomes. RESULTS: The mean nasal skin thickness was 3.3 mm for nasion, 2.4 mm for rhinion, 2.9 mm for nasal tip, and 2.3 mm for columella. Postoperative outcomes were classified as excellent in 45, good in 17, and poor in 15 patients. The excellent outcome group had the thinnest nasal tip and columella nasal skin (2.8 mm and 2.2 mm), whereas the poor outcome group had the thickest skin in these regions (3.4 mm and 2.6 mm) (P < .0001 and P = 0.01, respectively). CONCLUSION: Nasal skin is thickest over the nasofrontal angle, thins over the rhinion, is thick again in the nasal tip, and thins out over the columella. Thick skin at the nasal tip and columella was associated with poor surgical outcomes. Regional skin thickness appears to be an important prognostic factor for tip surgery success.

Asian sand dust enhances rhinovirus-induced cytokine secretion and viral replication in human nasal epithelial cells.

CONTEXT: Asian sand dust (ASD) originating in the arid deserts of Mongolia and China causes annual severe air pollution events in the Asia-Pacific area, including Korea, Japan, and China. ASD is thought to impact public health by aggravating or inducing respiratory illness. Among the most common respiratory illnesses is the common cold caused by rhinovirus (RV) infection. To date, however, the impact of ASD on RV infection has not been studied. OBJECTIVE: In this study, we investigated the effect of ASD on RV infection in human nasal epithelial cells. METHODS: Primary human nasal epithelial cells grown at an air-liquid interface were treated with ASD and/or RV. After RV infections were confirmed using semi-nested reverse transcription-polymerase chain reaction (RT-PCR), mRNA expression and protein secretion of the inflammatory cytokines interferon-γ (IFN-γ), interleukin-1ß (IL-1ß),IL-6, and IL-8, indicators of the severity of RV-induced inflammation, were measured by real-time PCR and enzyme-linked immunosorbent assays. Viral titer was also assayed by culturing viruses to compare viral replication between RV-only and ASD-plus-RV groups. RESULTS: ASD significantly increased RV-induced IFN-γ, IL-1ß, IL-6, and IL-8 mRNA levels and protein secretion in primary nasal epithelial cells. In addition, ASD caused a significant increase in RV replication. CONCLUSIONS: Our results suggest that ASD may potentiate common cold symptoms associated with RV infection not only by enhancing IFN-γ, IL-1ß, IL-6, and IL-8 secretion, but also by increasing viral replication.

Contributing factors to prevent prolonged epiphora after maxillectomy.

OBJECTIVE: To analyze the incidence of prolonged epiphora after maxillectomy according to transected nasolacrimal duct management technique, type of tumor, radiotherapy, and timing of tube removal and performance of dacryocystorhinotomy. DESIGN: Retrospective medical record review. Settings University hospitals. PATIENTS: We studied 89 patients (90 cases) who underwent nasolacrimal duct transection during maxillectomy with preservation of orbital contents for the management of sinonasal tumors between July 1, 1996, and January 31, 2008. MAIN OUTCOME MEASURES: The incidence of prolonged epiphora was analyzed according to 4 different transected nasolacrimal duct management techniques: simple transection without any additional procedure, silicone tube stenting, transcanalicular Silastic stenting, and marsupialization without stenting. We also analyzed the relationship between other factors (type of tumor, radiotherapy, and timing of tube removal) and the incidence of prolonged epiphora. Prolonged epiphora was defined as persistent if it lasted longer than 6 months. RESULTS: The overall incidence of prolonged epiphora was 15.6% (14 of 90 cases). The prolonged epiphora rates differed according to the management technique (no procedure, 27.3% [3 of 11 cases]; silicone tube, 7.0% [4 of 57 cases]; transcanalicular Silastic stenting, 66.7% [4 of 6 cases]; marsupialization, 18.8% [3 of 16 cases]; P = .002). The silicone tube technique showed the lowest rate (odds ratio = 0.20, P = .06). In contrast, the incidence of prolonged epiphora was not affected by the type of tumor, postoperative radiotherapy, or timing of tube removal. CONCLUSION: Silicone tube stenting can be used as the effective and convenient transected nasolacrimal duct reconstructive technique to prevent prolonged epiphora.

Rhinovirus infection-induced alteration of tight junction and adherens junction components in human nasal epithelial cells.

OBJECTIVES/HYPOTHESIS: Manifestations of rhinovirus (RV) infections include mucus overproduction, increased vascular permeability, and secondary bacterial infection. These effects may reflect disrupted epithelial barrier functions, which are mainly regulated by intercellular junctions, referred to as tight junctions (TJs) and adherens junctions (AJs). The objective of this study was to investigate changes in the components of TJs (ZO-1, occluding, and claudin-1) and AJs (E-cadherin) after RV infection in cultured nasal epithelial cells. METHODS: Primary human nasal epithelial cells grown at an air-liquid interface were infected apically with RV. RV-induced changes in the expression of epithelial TJ and AJ proteins were determined using real-time reverse transcriptase-polymerase chain reaction, confocal microscopy, and Western blot analyses. Functional changes in the integrity of junctional proteins were assessed by measuring transepithelial resistance (TER) using a voltmeter. RESULTS: RV infection decreased mRNA levels of ZO-1, occludin, claudin-1, and E-cadherin to 64.2%, 51.8%, 56.2%, and 56.3%, respectively, of those in controls (P < .05). Decreases in ZO-1, occludin, claudin-1, and E-cadherin protein levels in RV-infected cells were evident in immunofluorescent confocal microscopic images. Expression levels of these proteins were also lower in the RV-infected group in Western blot analyses. RV infection reduced the mean TER from 143.1 Omega/cm(2) (controls) to 122.6 Omega/cm(2). CONCLUSIONS: RV infection decreased the expression of TJ and AJ components and reduced TER in primary cultured human nasal epithelial cells, indicating that RV infection may exert a harmful effect on nasal epithelial barrier function.

Cutting and suture technique of the caudal septal cartilage for the management of caudal septal deviation.

OBJECTIVES: To introduce the cutting and suture technique of the caudal L-strut for the management of caudal septal deviation and to evaluate its efficacy and surgical outcomes. DESIGN: Retrospective study. SETTING: Tertiary care rhinology clinic. PATIENTS: Forty-five patients who underwent endonasal septoplasty using the cutting and suture technique of the caudal L-strut. INTERVENTIONS: After elevation of the mucoperichondrial flap, deviated portions of cartilage and bone were excised, leaving at least a 1.5-cm strip of L-strut. If caudal septal deviation persisted, the caudal strut was cut at the convex-most part, and the cut ends were slightly overlapped and sutured together. MAIN OUTCOME MEASURES: Improvement in the treatment of nasal obstruction using a visual analog scale and a questionnaire for subjective satisfaction were evaluated 2 to 6 months after septoplasty. To evaluate outcomes objectively, endoscopic photographs of the nasal cavity before and after surgery were evaluated by 2 independent surgeons. RESULTS: Significant improvement in the treatment of nasal obstruction was achieved, with mean visual analog scale scores of 7.93 preoperatively and 3.63 postoperatively (P < .001). Subjective satisfaction was rated as much improved in 68% of patients, improved in 15%, and no change in 17%. Endoscopic examinations showed that 51% of patients had near-complete correction of the septum and that 47% had improved but a little persisting caudal deviation. One patient had no change in caudal septal deviation on endoscopic examination. CONCLUSION: The cutting and suture technique of the caudal L-strut seems to be a useful technique that can be performed with relative ease and simplicity.

Rhinoplasty to correct nasal deformities in postseptoplasty patients.

BACKGROUND: Although not so common, septoplasty carries the risk of inducing nasal deformity such as saddle nose and deviated nose. Surgical correction for those deformities is a formidable task to deal with, because the septal cartilage framework was already weakened due to previous procedure. This study was designed to examine various causes and effective techniques of rhinoplasty for correction of nasal deformities after septoplasty. METHODS: Subjects comprised 19 patients who developed nasal deformities after septoplasty. Pre- and postoperative photographs were analyzed by two rhinoplastic surgeons. Anthropometric measurements of the external nose before and after surgery were made using frontal and lateral photographs to objectively evaluate outcomes. RESULTS: Intraoperative analysis showed that 5 patients had weak L-struts and 13 patients had displaced caudal septa. Septum was reconstructed using costal cartilage in 13 cases. Spreader grafting was performed in 13 patients and caudal septal extension grafts were performed in 10 patients. All but 1 patient had successful functional and esthetic outcomes. In the saddle nose group, all parameters except nasolabial angle were significantly improved. In the deviated nose group, curved deviated angles were completely corrected, whereas the linear deviated angle was not. CONCLUSION: Loss of caudal septal support appears to be a major reason for nasal deformity after septoplasty. The best surgical approach for septal cartilage framework reconstruction appears to involve the use of bilateral spreader or septal extension grafts using costal cartilage.

Use of nasal septal bone to straighten deviated septal cartilage in correction of deviated nose.

OBJECTIVES: Septoplasty for correction of deviated nose often requires removal of the deviated part of the quadrangular cartilage and the perpendicular plate of the ethmoid bone or vomer. In most cases, the removed bone is discarded. We describe our experience using septal bone for deviated nose correction, and analyze the postoperative results. METHODS: A retrospective study was performed on 23 patients who underwent correction of deviated nose using nasal septal bone to straighten deviated septal cartilage from January 2004 to August 2008. The subjective satisfaction of patients was evaluated 6 to 12 months after rhinoplasty with a questionnaire. Aesthetic outcomes were evaluated by 2 independent rhinoplastic surgeons who compared preoperative and postoperative photographs. To evaluate outcomes objectively, we made anthropometric measurements of the deviated nose before and after surgery using facial photographs. RESULTS: All patients indicated cosmetic satisfaction and improvement in nasal obstruction. The outcome analysis by 2 independent rhinoplastic surgeons indicated that 13 patients had excellent, 5 patients had good, and 5 had fair outcomes. Anthropometric measurements of the deviated nose showed that both the curved deviated angles and the linear deviated angle had improved (p < 0.05). CONCLUSIONS: Use of nasal septal bone to straighten deviated septal cartilage appears to be feasible in corrective rhinoplasty, and may be particularly beneficial in cartilage-depleted patients.

Levocetirizine inhibits rhinovirus-induced ICAM-1 and cytokine expression and viral replication in airway epithelial cells.

Levocetirizine inhibits the production of intercellular adhesion molecule (ICAM)-1 and secretion of interleukin (IL)-6 and IL-8, which may have beneficial effects on the pathophysiologic changes related to human rhinovirus (HRV) infection. We investigated the effects of levocetirizine on rhinovirus infection in primary human nasal epithelial cells (HNEC) and A549 cells. Cells were treated with different concentrations of levocetirizine, ranging from 0.5, 5 or 50nM, either starting at the time of infection and continuing thereafter, or beginning 24h before infection and continuing thereafter. Levocetirizine treatment inhibited the HRV-induced increase in ICAM-1 mRNA and protein levels, as well as the HRV-induced expression of IL-6 and IL-8 mRNA and protein levels. Viral titer, as measured by culture in MRC-5 cells, was reduced by levocetirizine. Levocetirizine treatment also reduced the increased nuclear factor-kappa B (NF-kappaB) expression seen with HRV infection. Levocetirizine inhibited the expression of Toll-like receptor (TLR)3 mRNA and protein levels. These findings indicate that, in HNEC and A549 cells, levocetirizine inhibits HRV replication and HRV-induced upregulation of ICAM-1, IL-6, and IL-8, TLR3 expression and NF-kappaB activation. The results of this study suggest that levocetirizine may have a possible clinical application in the treatment of airway inflammation caused by HRV infection.

Utility of 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography and positron emission tomography/computed tomography imaging in the preoperative staging of head and neck squamous cell carcinoma.

The combination of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) has been reported to be more accurate than CT or PET alone in a preoperative setting. We compared the diagnostic utility of preoperative PET/CT, PET and CT/MRI in 167 patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC), of whom 104 underwent FDG PET and 63 underwent combined PET/CT with all receiving CT/MRI. These preoperative PET, PET/CT, and CT/MRI results were reviewed and their accuracies were compared in patients in whom diagnosis was confirmed histopathologically. Age, sex, primary sites and stage, and nodal involvement were comparable between two groups. The accuracy of PET and PET/CT for detecting primary tumors and cervical metastases was comparable, but significantly higher than that of CT/MRI (98%-97% vs. 86-88% for primary; 92%-93% vs. 85%-86% for neck on a level-by-level basis; P<.05). PET and PET/CT gave false negative results: in 2 (2%) and 2 (3%) patients for primary tumors; in 6 (6%) and 3 (5%) patients for neck metastases, respectively. PET and PET/CT also gave false-positive results for cervical metastases in 5 (5%) and 4 (6%) patients, respectively. Compared with PET alone, preoperative FDG PET/CT may not yield significantly improved diagnostic accuracy in patients with HNSCC. Moreover, despite their high accuracy, PET and PET/CT may not abrogate the need for conventional imaging and pathologic staging based on primary resection and neck dissection.