Functional endoscopic sinus surgery improves the quality of life in children suffering from chronic rhinosinusitis with nasal polyps.

OBJECTIVE: To evaluate the impact of FESS in children with chronic rhinosinusitis with nasal polyps, regarding their overall postoperative quality-of-life (QoL) and constituent QoL domains. Potential differences between cystic fibrosis (CF) sufferers and non-sufferers, or cases with recurrent sinonasal polyposis versus single-operations were also explored. METHODS: 39 children were studied. The mean patient age was 10.9 years; four children suffered from cystic fibrosis. The children (or parents) completed the Glasgow Benefit Inventory for Children (GCBI) at least six months after their operation. The Mann-Whitney test compared the GCBI scores between non- and CF sufferers, as well as children with and without recurrent polyposis. RESULTS: The median overall QoL score was 98. There were no statistically significant differences between CF sufferers and non-sufferers regarding their overall QoL, or the respective individual QoL domains, apart from their physical postoperative activity (p = 0.04). Twelve children demonstrated recurrent polyposis (30.7%); among them three were cystic fibrosis sufferers. No statistically significant differences were identified in the overall QoL score, or individual GCBI subscale scores between children with recurrent polyposis versus single-operations. Children with recurrent polyposis but not CF performed better regarding their overall QoL (p = 0.021) and medical status (p = 0.015), compared to their CF counterparts. CONCLUSION: FESS performed for chronic rhinosinusitis with nasal polyps in children is associated with improved postoperative QoL, irrespective of the presence of CF (although the latter needs to be confirmed in larger patient cohorts). The absence of appreciable differences in the overall QoL, or its constituent domains, between single and re-operated children, indicate that the positive effect of FESS outweighed the burden of re-operation. Appropriate preoperative informed consent in cases of recurrent sinonasal polyposis necessitates acknowledging worse respective outcomes in CF sufferers.

Functional endoscopic sinus surgery improves sinus-related symptoms and quality of life in children with chronic rhinosinusitis: a systematic analysis and meta-analysis of published interventional studies.

AIM: To assess the current knowledge and evaluate the quality of evidence in the use of FESS for the treatment of chronic rhinosinusitis in children, regarding the respective changes in the quality-of-their-life (QoL) and the outcome that follows the operation. MATERIALS/METHODS: Systematic literature review in Medline and other database sources and meta-analysis of pooled data. RESULTS: 15 studies were systematically analyzed. Four represented Level II, five Level III, and six Level IV evidence. The total number of treated patients was 1301. Thirteen research groups reported that pediatric FESS is an effective treatment for chronic rhinosinusitis; the respective positive outcome ranged between 71 and 100% of operated children. Five studies concluded that this treatment modality is associated with significant improvement in the children's postoperative QoL. Systemic diseases and environmental factors may have unfavourable prognostic effects; cystic fibrosis is associated with at least 50% recurrence rate. The rate of major complications following pediatric FESS is 0.6%, and the respective rate of minor complications 2%. CONCLUSION: The surgical management in children with chronic rhinosinusitis, despite the reservations expressed by many clinicians, is effective when optimal medical treatment proves unsuccessful (grade B strength of recommendation), and is associated with improvement in the children's QoL (grade B strength of recommendation). FESS also improves the sinusitis-associated symptoms and QoL in children with cystic fibrosis (grade C strength of recommendation. Most complications of pediatric FESS reported in the literature are minor, and associated with difficulties in the postoperative assessment and care of pediatric patients.

Cyclin D1 protein tissue detection in laryngeal cancer.

Cyclin D1 (CCND1) is a set of periodic regulatory proteins that is believed to govern cell cycle transit from G1 into S phase. Overexpression of CCND1 leads to abnormal cellular proliferation which underlies processes of tumorigenesis; CCND1 can thus function as a cooperative oncogene in cell transformation. In the present study we investigate the immunohistochemical expression of CCND1 in a well-documented series of 58 laryngeal squamous cell carcinomas (LSCC) and search for statistical associations between CCND1 index and various clinicopathological parameters including several immunomarkers' expression as well as patients' disease-free survival. Tissue sections from archival paraffin blocks were stained using the avidin-biotin-peroxidase complex method; the H-295 rabbit polyclonal antibody was applied at dilution of 1:150. The percentage of CCND1 immunoreactive tumor cells for each tumor was counted by an image analysis system. CCND1 staining was confined to cell nuclei and, in the examined samples, ranged from undetectable (i.e. 0% of tumor cells, n = 6) to the majority of tumor cells (i.e. 89% of tumor cells) with mean value: 15.73%. In tumor adjacent, non invasive lesions, strong CCND1 staining was noticed in areas with cellular atypia. In cases with nodal metastases, no change in CCND1 expression in the nodal metastases compared with the primary tumors was observed. p53 protein accumulation in malignant cells was positively linked with CCND1 index (Mann-Whitney U: 205.5, p = 0.034). CCND1 expression appears to be an early event in processes of tumorigenesis and tumor progression in some LSCC. Apart from p53 protein accumulation, CCND1 immunohistochemical expression does not seem to correlate with nodal metastasis, disease recurrence or any other clinicopathological prognostic indicator.

Professor Nicolas Taptas (1871-1955): a pioneer of post-laryngectomy voice rehabilitation.

OBJECTIVE: To report on the career of Professor Nicolas Taptas of Constantinople (1871-1955) and his contribution to the development of an artificial larynx. STUDY DESIGN: Historical review. METHODS: The unpublished documents of Taptas's family archives and one of his papers, describing his own original technique for voice rehabilitation after total laryngectomies, were studied. RESULTS: In his texts, Taptas described the application of external laryngeal prostheses in one of his patients who underwent total laryngectomy. Taptas meticulously recorded his own first successful attempt in a woman with cancer of the larynx. He was one of the first scientists who, at the end of the 19th century, devised an external laryngeal prosthesis, which had the advantage of rehabilitating a sufficiently strong whispering voice; by using a prototype valve, he avoided problems of aspiration of liquids and food to the bronchi. CONCLUSION: Nicolas Taptas's contribution to the development of the artificial larynx was vital because he devised and applied one of the first external laryngeal artificial prostheses with satisfactory functional results.

From the roots of rhinology: the reconstruction of nasal injuries by Hippocrates.

The goal of this report is to describe the therapeutic methods and surgical techniques used by Hippocrates (5th century BC) in the treatment of nasal injuries. We studied the original Greek texts of the (generally considered genuine) Hippocratic book Mochlicon and, especially, the analytical On Joints. We identified the treatments and techniques applied to the restoration of injured noses. We found that Hippocrates classified nasal injuries, from simple contusions of soft tissues to complicated fractures. Hippocrates provided detailed instructions for each case, from poultice application and bandaging to reconstruction and reshaping of the nasal bones in cases of fractures and deviation. Hippocrates' texts reflect the interest of the classical period in nasal injuries, a common enough accident in athletics. Hippocratic conservative and surgical management for each form of injury was adopted by later physicians and influenced European medicine.