Treatment of non-tuberculous mycobacterial cervicofacial lymphadenitis in children: critical appraisal of the literature.

BACKGROUND: Surgical excision has historically been the treatment of choice for non-tuberculous mycobacterial cervicofacial lymphadenitis. Emerging data suggests antibiotic treatment alone could be an attractive alternative to surgery. We questioned (1) what treatment offers best cure rates in children with this condition and (2) the evidence for antibiotic treatment alone. TYPE OF REVIEW: Structured literature search according to the Evidence Based Medicine guidelines. SEARCH STRATEGY/METHODS: A structured search was conducted in PubMed, Embase and the Cochrane Library from 1966 up to November 2007. Relevant papers were critically appraised. RESULTS: Six papers were included, one of which was a randomised controlled clinical trial (RCT). In general, treatment sequencing was not consistent. Surgery and medical treatment were often used in combination, resulting in high overall cure rates. In the RCT surgery and antibiotic treatment were compared as single modalities. The outcome of surgery was far superior (96%versus 66% cure rate, respectively). Other studies indicated that substantial cure rates (up to 67%) were achieved with medical management alone, but failed to identify factors predicting response. CONCLUSION: Surgical excision still is the backbone in the management of cervicofacial non-tuberculous mycobacterial lymphadenitis, although a considerable number of children can be cured with antibiotics alone or combined modality treatment. To date it is unclear which subset of patients can benefit from antibiotic treatment only.

A review of sinonasal outcome scoring systems - which is best?

* In patients undergoing endoscopic sinus surgery for chronic rhinosinusitis, there is a lack of a universally accepted system for the evaluation of outcome. * This makes critical comparison between results less meaningful. * To determine the most suitable sinonasal outcome scoring system for use in our own practice, we reviewed the available literature and known systems in existence. * We analysed 15 known disease-specific sinonasal outcome indices with emphasis on reliability, validity and responsiveness. * We concluded by choosing one quality of life outcome tool for our departmental use, the Sinonasal Outcome Test-22, due to its reliability, validity, responsiveness and ease of use. * It has been validated to distinguish between disease-affected patient groups and those without rhinosinusitis, demonstrate a worse score if the condition gets worse and show an appropriateness of items and scales in the questionnaire. This has been demonstrated in 3128 British patients.

Diamine containing VLA-4 antagonists.

Design and synthesis of a library as potential VLA-4 antagonists has been accomplished, based around a proposed pharmacophoric model. Compounds possessing submicromolar potency were identified and structure-activity relationships were seen across the library. Further derivatisation produced compounds with IC(50)'s <10 nmol for inhibiting the VLA-4 mediated binding of fibronectin to RAMOS cells, providing an ideal starting point for a lead optimisation Programme.