Expression of cyclooxygenase and lipoxygenase enzymes in sinonasal mucosa of patients with cystic fibrosis.

OBJECTIVE: To evaluate the expression of cyclooxygenase (COX) and lipoxygenase (LO) enzymes in the sinonasal mucosa of patients with cystic fibrosis (CF). DESIGN: Immunohistochemical staining of archived tissue. PARTICIPANTS: Specimens from 9 patients with CF were analyzed; control specimens were obtained from 4 patients without a history of CF or rhinosinusitis. INTERVENTIONS: Expression of the enzymes COX-1, COX-2, 5-LO, 12-LO, and 15-LO was evaluated with the use of immunohistochemical techniques in archived sinonasal mucosal tissue from patients with CF. These results were compared with those of the control group. RESULTS: We noted the characteristic staining patterns of epithelium and submucosal glands for each enzyme. Statistically significant (P < .05) differences between control and CF specimens were noted in the staining intensity of columnar epithelium for COX-2 (cytoplasm) and 12-LO (cytoplasm and nucleus) and of submucosal glands for COX-2 (cytoplasm) and 12-LO (cytoplasm). No significant differences were noted for the staining intensity of COX-1, 5-LO, or 15-LO between the groups. CONCLUSIONS: Significant differences in sinonasal mucosal expression of COX-2 and 12-LO enzymes exist between patients with CF and controls. This suggests a difference in arachidonic acid metabolism between these 2 groups.

Expression of cyclooxygenase and lipoxygenase enzymes in nasal polyps of aspirin-sensitive and aspirin-tolerant patients.

OBJECTIVE: To evaluate the expression of cyclooxygenase (COX) and lipoxygenase (LO) enzymes in nasal polyp specimens from aspirin-sensitive (AS) and aspirin-tolerant (AT) patients. DESIGN: Immunohistochemical staining of archived tissue. Subjects Specimens from 26 patients (11 AS and 15 AT) with nasal polyps were analyzed; specimens from 4 patients were used as controls. INTERVENTIONS: Immunohistochemical techniques were used to evaluate the expression of the enzymes COX-1, COX-2, 5-LO, 12-LO, and 15-LO in nasal polyp tissue specimens from AS and AT patients. The results were compared with those of a control group of patients without a history of nasal polyposis or rhinosinusitis. RESULTS: Characteristic staining patterns of epithelium and submucosal glands were noted for each enzyme. Statistically significant (P<.05) differences in staining of columnar epithelium were noted for COX-1 (basal cell layer cytoplasm), COX-2 (apical cell layer cytoplasm), and 12-LO (full-thickness cytoplasm and nucleus). Increased 15-LO (full-thickness cytoplasm) expression in columnar epithelium was noted only in the AT group. Significant differences in the staining of submucosal glands were noted for COX-2 (plasma membrane and cytoplasm), 12-LO (cytoplasm), and 15-LO (cytoplasm) between control and AS patients as well as between control and AT patients (P<.05). The only significant difference noted between the AS and AT groups was cytoplasm staining for 5-LO in submucosal glands, which was greater in the AS group. No epithelial staining differences were noted between AT and AS patients. CONCLUSIONS: There were significant differences in the expression of COX and LO enzymes between patients with nasal polyps and controls, irrespective of aspirin sensitivity. With 1 exception, there were no significant differences between AS and AT groups.

Future directions in the treatment of oral cancer.

Future developments in the realms of nanotechnology and directed therapeutics will alter the diagnosis and treatment of oral cancer relative to contemporary treatment modalities. Continued experience and investigation will determine the clinical usefulness of the various technologies that have been described in this article.

Soft tissue implants and fillers.

The number and variety of soft tissue implants and fillers at the clinician's disposal continues to increase rapidly as new materials and bioengineering techniques evolve. The ideal implant for all purposes does not yet exist, so the clinician must be familiar with a wide variety of products for each application. Continued advances in synthetic, allogeneic, and autologous products and experience with existing products will further augment the surgeon's armamentarium in the coming years.

The role of postoperative adjuvant radiation therapy in the treatment of mucosal melanomas of the head and neck region.

BACKGROUND: Mucosal melanoma of the head and neck is uncommon, and has a poor prognosis due to locoregional and distant failure. The optimal treatment paradigm for patients with this disease has yet to be determined. OBJECTIVE: To compare the outcomes of patients treated with various commonly used protocols for mucosal melanoma of the head and neck. DESIGN: Retrospective study. SETTING: Academic tertiary referral center. PATIENTS: The medical records of 48 consecutive patients treated at a single institution from January 1, 1985, to December 31, 1998, were reviewed. INTERVENTIONS: Patients were treated with surgery alone, surgery and adjuvant radiotherapy, or surgery and biochemotherapy, with or without adjuvant radiotherapy. MAIN OUTCOME MEASURES: The outcomes of disease recurrence and survival were correlated with the treatment received. RESULTS: Twenty patients received surgical treatment alone; in 9 patients (45%), this treatment failed locoregionally, and 10 (50%) of the patients developed distant metastases. The 5-year survival rate was 45% (9 of 20 patients). Twenty-four patients received postoperative adjuvant radiotherapy; in 4 patients (17%), this treatment failed locally, and 11 (46%) of the patients developed distant metastases. The 5-year survival rate was 29% (7 of 24 patients). CONCLUSION: The addition of radiotherapy tended to decrease the rate of local failure (P =.13), but did not significantly improve survival (P =.73), because of the high rate of distant metastatic disease.

Malignant melanoma in the palate of a 3-month-old child.

BACKGROUND: Malignant mucosal melanoma of the head and neck is a rare cancer in adults that carries a grave prognosis. Three mucosal melanomas in pediatric patients have previously been reported. METHODS: We present here the youngest case of malignant mucosal melanoma of the head and neck in a 3-month-old boy. He presented with a 2 x 2-mm-pigmented lesion on the anterior maxillary alveolus. The patient was treated with local excision alone. RESULTS: The patient has remained disease free with regular follow-up for 117 months. CONCLUSION: Based upon this case and the few cases reported in the literature, mucosal melanoma is a much less common disease in children than in adults. Further, juvenile mucosal melanoma displays a benign clinical behavior.