Biomedical subjects

Donald C Lanza

Publications and source records attributed to Donald C Lanza.

31 records · Page 2Linked to original sources

PubMedDate not supplied

Characterization of oxidative pathways in chronic rhinosinusitis and sinonasal polyposis.

BACKGROUND: Eosinophils are a characteristic inflammatory cell infiltrate in both chronic rhinosinusitis (CRS) and sinonasal polyposis (SNP). The posttranslational modifications, 3-bromo-tyrosine (Br-Tyr) and 3-chloro-tyrosine (Cl-Tyr), serve as specific molecular markers for production of brominating and chlorinating oxidants, respectively, by the eosinophil peroxidase and myeloperoxidase systems of leukocytes. The aim of this study was to identify mechanisms of oxidative protein modifications in sinonasal mucosa of CRS and SNP patients by measuring Br-Tyr, Cl-Tyr, and alternative molecular markers of distinct oxidative pathways. METHODS: Levels of Br-Tyr; Cl-Tyr; di-Tyrosine (di-Tyr), a specific oxidative cross-link; ortho-tyrosine (o-Tyr) and meta-tyrosine (m-Tyr), markers for protein modification by hydroxyl radical-like oxidants; and nitro-tyrosine (NO2-Tyr), a stable product of nitric oxide (NO)-derived oxidants, were measured in anterior ethmoid mucosa tissue from CRS and SNP patients, as well as in middle turbinate mucosa from normal volunteers, using tandem mass spectrometry. RESULTS: Tissue levels of Br-Tyr were significantly higher in the CRS group compared with the control group (797 micromol/mol versus 515 micromol/mol tyrosine, p < 0.015), but no differences were detected for Cl-Tyr, di-Tyr, m-Tyr, o-Tyr, and NO2-Tyr. Tissue levels of both Br-Tyr and di-Tyr were significantly higher in the SNP group compared with the control group (879 micromol/mol versus 515 micromol/mol, p < 0.005; 5090 micromol/mol versus 1700 micromol/mol, p < 0.024, respectively), but no differences were detected for Cl-Tyr, m-Tyr, o-Tyr, and NO2-Tyr. CONCLUSION: Br-Tyr, a molecular footprint predominantly formed by eosinophil peroxidase-catalyzed tissue damage, may serve as an objective index of CRS and SNP disease activity.

Adult↗

PubMedDate not supplied

Sinus inflammation associated with contralateral inverted papilloma.

OBJECTIVE: To assess with computerized tomography (CT) the association of unilateral inverted papilloma (IP) and contralateral sinus inflammation. DESIGN: Retrospective analysis of CTfindings in a sample of patients with unilateral IP, a sample with other unilateral sinonasal tumors, and normal controls. PATIENTS AND METHODS: Sixteen patients with unilateral IP comprised the study population. Nine patients with other unilateral sinonasal tumors (five with squamous papilloma, two with squamous cell carcinoma, and one each with adenocarcinoma and large cell carcinoma) were used as a comparison population. Patients undergoing maxillofacial CTfor nontraumatic orbital conditions comprised the control sample (n = 12 sides). Each patient's preoperative CT scan was evaluated with a modified Lund-Mackay scoring system. The scores for the sides opposite the IPs were compared with the sides contralateral to other sinonasal tumors as well as to normal controls. RESULTS: Analysis of all three samples' contralateral sides simultaneously using analysis of variance revealed a difference (p = 0.010). The contralateral sinus scores in IPs tended to be higher than the sides opposite the other sinonasal tumors (mean, 2.66 +/- 1.07 versus 1.18 +/- 0.76; p = 0.06). These in turn were higher than the normal controls (mean, 0.75 +/- 0.48; p < 0.02). CONCLUSIONS: Unilateral IPs are associated with contralateral inflammation as detected by CT. This degree of contralateral inflammation is greater than that seen in other sinonasal tumors. The etiology of this association is unclear. A recent histological review suggested IP is an inflammatory polyp and not a true papilloma. Our data further suggest inflammation may be involved in the pathogenesis of IP. Further work is needed to better understand the pathophysiology and behavior of IP and to define its relationship to sinus inflammation.

Humans↗

PubMedDate not supplied

A comparison of endoscopic culture techniques for chronic rhinosinusitis.

BACKGROUND: Recent evidence suggests that endoscopically obtained cultures from the middle meatus give comparable results to antral puncture for acute sinusitis. The best method for obtaining middle meatal cultures remains somewhat controversial because it has been theorized that specimens obtained with a swab are contaminated easily. This study compares endoscopic culture results from two different methods: swab and aspiration. Specifically, this study sought to determine whether or not the culture contamination rate is higher using the swab versus an aspiration technique. METHODS: One hundred consecutive culture specimensfrom 81 chronic rhinosinusitis patients were compared. Fifty cultures were obtained using a swab technique (group I) and another 50 cultures were obtained by aspirating pathological material into a sterile suction trap (group II). The patient populations in each group were similar; there were no differences in terms of age, gender, comorbid medical conditions, or prior medical therapy. Cultures were considered contaminated if they yielded normal nasal flora or if rare or few Staphylococcus coagulase-negative colonies grew after no bacteria was identified in gram stain. Staphylococcus aureus, Staphylococcus coagulase-negative, and Pseudomonas aeruginosa were the three most common organisms in both groups. RESULTS: Gram-negative bacteria were noted in 21/60 (35%) positive cultures. Although the contamination rate of the suction aspiration group (14%) was less than the endoscopic swab group (10%), this did not approach statistical significance (p = 0.75). CONCLUSIONS: Data from this study suggest that endoscopically guided aspiration of pathological material is no better than properly obtained swabs in directing antimicrobial therapy for chronic rhinosinusitis.

Adolescent↗

PubMedDate not supplied

Inflammation and the pathogenesis of inverted papilloma.

BACKGROUND: Despite existing clinical and histopathological evidence, the role of inflammation in the pathogenesis of inverted papilloma (IP) is not well understood The goal of this study was to describe the inflammatory cell component present in sinonasal papilloma (SP), with the intention of further defining the existence of inflammation in IP and perhaps gaining insight into IP pathophysiology. METHODS: Computerized database analysis was performed to identify all patients with SP who underwent surgery at the Cleveland Clinic Foundation between 1995 and 2001. Histopathological features of all SP were reviewed and semiquantitative analysis of the inflammatory cells present was performed. IP was histopathologically graded into four categories by the extent of inflammatory infiltrate and cellular atypia. Statistical analysis of the inflammatory cell component present in the epithelial layer of exophytic papilloma and IP was performed. RESULTS: SP was classified into three types: cylindrical papilloma (5% [2/41]), exophytic squamous papilloma (34% [14/ 41]), and IP (61% [25/41]). Twenty-eight instances of IP in 25 patients were identified. Altogether, 11% were grade I (3/28), 54% were grade II (15/28), 25% were grade III (7/28), and 11% were grade IV (3/28). The inflammatory cell population was significantly greater in IP compared with other SPs and greater in grades I and II IP when compared with grade III and IV IP. CONCLUSION: Inflammatory cells were identified as a significant cell population in IP, whereas it was less commonly encountered in other forms of SP. The proposed IP staging system may serve as the foundation for improved understanding of IP and, ultimately, may help to predict recurrence or apparent malignant transformation.

Biopsy, Needle↗

PubMedDate not supplied

Quantitative computer-aided computed tomography analysis of sphenoid sinus anatomical relationships.

BACKGROUND: This study describes a novel computer-generated anatomic symmetry plane as a framework for the quantitative description of sphenoid sinus anatomy. The aim of this study was to (1) determine relationships and distances between a midline sphenoid reference point (called the central sphenoid point [CSP]) and lateral sphenoid wall structures and (2) assess the incidence of anterior clinoid process (ACP) pneumatization and pterygoid recess (PR) pneumatization. METHODS: Axial computed tomography (CT) scans (1-mm slice thickness) were obtained on a VolumeZoom CT scanner (Siemens Medical, Erlangen, Germany). Mathematically derived anatomic symmetry planes were created using custom postprocessing software. A standardized review of each CT scan using surgical planning software (CBYON Suite version 2.6; CBYON, Mountain View, CA) was performed. The CSP was defined as a reference point in the midline sagittal plane at the intersection of the vertical sellar face and the horizontal sellar floor. RESULTS: A total of 128 sides in 64 cadaveric specimens were available for review. The incidences of ACP pneumatization and PR pneumatization were 23.4 and 37.5%. The mean distances from the CSP to the left optic canal midpoint, the left ACP entrance point, and the left PR lateral wall were 17.2, 15.6, and 27.6 mm, respectively. The corresponding distances from the CSP on the right side were 17.3, 15.8, and 28.0 mm, respectively. Measurements from the maxillary spine to the optic canal midpoint, ACP entrance point, and PR lateral wall on each side were performed also. CONCLUSION: This approach provides both quantitative and qualitative understanding of sphenoid osteology and may be coupled with intraoperative surgical navigation to reduce the risks of sphenoid surgery. Both PR and ACP pneumatization are surprisingly common. Because the CSP-derived relationships may be referenced during endoscopic surgical navigation, they may provide greater clinical utility than traditional alternatives. This paradigm may facilitate a greater understanding of sphenoid anatomy and enhance surgical safety and precision.

Adult↗

PubMedDate not supplied

Software-enabled computed tomography analysis of the carotid artery and sphenoid sinus pneumatization patterns.

BACKGROUND: The critical relationship of the carotid artery with the sphenoid sinus has been long established. Sophisticated imaging software in conjunction with three-dimensional high-resolution computed tomography (CT) imaging now facilitates detailed analysis of these anatomic relationships. METHODS: Siemens VolumeZoom CT scanner was used to obtain high-resolution computed tomography data that was subsequently transferred to the CBYON Suite Doctor Station version 2.6 for analysis. Various surgical planning tools were used for evaluating the CT scans. The relationship of the carotid artery with the sphenoid sinus was delineated. RESULTS: One-hundred twenty-eight sides in 64 cadaveric specimens were reviewed. Pneumatization of the sphenoid sinus was classified into four categories: conchal, presellar, sellar, and postsellar. The incidence of these four types was 4.7, 4.7, 25, and 65%, respectively. Carotid artery exposure was categorized as follows: no exposure, <90 degrees, >90 to <180 degrees, and >180 degrees. The incidence of the carotid exposure was 12.5, 32.8, 50, and 4.7%, respectively. Septal insertions onto the carotid artery were noted in 37.5% and dehiscences in 19.5% of the specimens. CONCLUSION: Computer-aided CT analysis allows for a detailed study of the critical relationship of sphenoid pneumatization and carotid artery position. Such technology can be invaluable in surgical planning and navigation during endoscopic sinus surgery. In lieu of these findings, sinus surgeons must exercise extreme caution when operating in this region to prevent unintentional injury to the carotid artery.

Carotid Artery, Internal↗

PubMedDate not supplied

Endoscopic resection of sinonasal malignancies: a preliminary report.

BACKGROUND: A minimally invasive endoscopic approach for the management of sinonasal malignancy offers several advantages including excellent illumination, maximal preservation of uninvolved vital structures, and sparing of facial incisions. The purpose of this study was to evaluate the outcome and morbidity of endoscopic resection with or without combined radiotherapy and/or chemotherapy. METHODS: Forty-seven patients with sinonasal malignancy were diagnosed and/or treated with an endoscopic approach at The Cleveland Clinic Foundation and The University of Pennsylvania Medical Center from 1996 to 2003. Nineteen patients fulfilled the study criteria and had a minimally invasive endoscopic resection. Fifteen patients were treated with curative intent and four patients underwent palliative resection. RESULTS: The mean age was 56.9 (9-78 years) years and the mean follow-up period was 26.4 months. Combined radiation with or without chemotherapy pre- or postoperatively was given to 15 of 19 (78.9%) patients. Thirteen patients were resected strictly with an endoscopic approach and six patients were resected in combination with neurosurgery. There were no peri- and postoperative deaths. The local recurrence (LR) rate was 26.3% (5/19) and the distant metastasis rate was 15.8% (3/19). Overall survival rate (OS) was 78.9% (15/19) at a mean follow-up duration of 32.1 (4-74 months) months. The disease-free survival (DFS) rate was 68.4% (13/19) by clinical, endoscopic, and radiographic surveillance at a mean follow-up duration of 33.1 months. Patients treated with curative intent had LR, OS, and DFS rates of 21.4, 85.7, and 85.7%, respectively, and the patients treated for palliation had LR, OS, and DFS rates of 40, 60, and 15%, respectively. CONCLUSION: Minimally invasive endoscopic resection of sinonasal malignancy in combination with adjunctive therapies reduces treatment morbidity and yields LR, OS, and DFS rates that are comparable with traditional anterior craniofacial approaches.

Adult↗

PubMedDate not supplied

An assessment for the presence of bacterial contamination of Venturi principle atomizers in a clinical setting.

BACKGROUND: Venturi principle atomizers have been criticized for potential contamination and disease transmission when used for nasal application. A recent laboratory study reported a high rate of contamination of these atomizers after their tips were immersed and sprayed into a broth containing Staphylococcus aureus. The objective of this study was to determine whether the Venturi-type atomizers used regularly at a busy referral center for sinonasal disorders were contaminated with bacteria. METHODS: Fifteen Venturi-type atomizers containing 2% lidocaine (four bottles), 4% lidocaine (three bottles), or 0.05% oxymetazoline (eight bottles) were sprayed onto blood agar plates. All atomizer bottles had been in routine use in a tertiary rhinology clinic for 1 month. The contents within each bottle's reservoir also were cultured. Thus, the total sample size was 30 plates. Then, the plates were incubated at 35 degrees C for 48 hours and then at room temperature for 72 hours. RESULTS: Three of our 30 plates grew one colony each of Gram-positive bacilli, Gram-positive cocci, and Staphylococcus species. CONCLUSION: The rare growth of any bacteria seen in our samples could as likely represent contamination during processing and handling of the plates as contamination of the atomizers themselves. Thus, Venturi-type atomizers may not have a high potential contamination risk, which has been suggested by previous reports.

Colony Count, Microbial↗

PubMedDate not supplied

Isolated sphenoid sinusitis after transsphenoidal hypophysectomy.

BACKGROUND: Literature addressing the incidence and management of sinusitis after transsphenoidal hypophysectomy is sparse. METHODS: Retrospective chart analysis was conducted on 200 consecutive patients who had undergone transsphenoidal procedures between January 1998 and December 2001. The postoperative incidence of sinusitis was determined. Clinical characteristics, management strategy, and outcome were reviewed. RESULTS: Fifteen of the 200 patients (7.5%) developed rhinosinusitis after transsphenoidal surgery. Seven of the patients were referred to otorhinolaryngology for further management. Three additional patients, who had undergone transsphenoidal hypophysectomy at outside institutions, also were evaluated during this time. Nine of 10 patients (90%) had isolated sphenoid sinusitis by computed tomography and/or endoscopic criteria. The most common symptoms included headaches and nasal discharge present for an average of 2.9 years. Medical management resulted in resolution of symptoms in 5 of 10 cases (50%). The remaining five patients required endoscopic sphenoidotomy for recalcitrant disease. Intraoperatively, fungal balls were identified in three cases. Mucocele formation was encountered in one case, and an infected fat graft was evident in one case. Sphenoid sinusitis was resolved successfully in all 10 cases. CONCLUSION: A high index of suspicion must be maintained to avoid an inordinate delay in diagnosis of isolated sphenoid sinusitis in this setting, in light of the nonspecific presentation of this clinical entity. Aggressive medical and/or surgical treatment is required for resolution of refractory symptoms in this patient population.

Female↗

PubMedDate not supplied

Challenges in the management of sphenoid inverted papilloma.

BACKGROUND: Inverted papilloma (IP) arising in the sphenoid sinus is extremely rare. Management of sphenoid sinus IP is especially challenging because of the paucity of sinonasal symptoms on presentation and the inherent surgical risks associated with the anatomic location of the sphenoid sinus. METHODS: We performed a retrospective review of medical records of all patients with IP arising within the sphenoid sinus. RESULTS: A total of five patients were identified. All patients were managed with endoscopic resection. The most common presenting symptom was headache (three patients). The mean follow-up period was 37.6 months (range, 10-79 months). Two patients with erosive skull base lesions adjacent to the internal carotid artery were managed with a staged endoscopic resection. Only one patient developed a recurrence after 38 months and underwent revision endoscopic resection. CONCLUSION: Endoscopic management of sphenoid IP allows maximal resection with minimal morbidity and facilitates endoscopic postoperative surveillance. Complete preoperative radiological assessment of tumor extent is essential. Preoperative medical therapy can help normalize inflamed mucosa and minimize intraoperative bleeding. For large erosive IP, surgical risks may be minimized by considering a staged resection and using computer-aided surgery.

Adult↗

PubMedDate not supplied

Endoscopic power-assisted orbital exenteration.

BACKGROUND: Orbital exenteration can be accomplished by either an external eyelid-sparing or eyelid-sacrificing approach. The purpose of this study was to describe an alternative technique for orbital exenteration and its specific advantages over traditional methods. METHODS: A retrospective analysis at a tertiary care referral center was performed. Three patients with sinonasal malignancy (two cases) and fulminant invasive fungal sinusitis (one case) are reported. Intraconal involvement was evident in all patients by imaging and surgical pathology. Advanced endoscopic techniques in conjunction with image guidance and soft-tissue shaver technology were used for resection in all cases. RESULTS: The orbit was successfully exenterated via an eyelid-sparing endoscopic approach with minimal blood loss in all three patients. Exenteration was completed within 30-45 minutes. Uninvolved superior and lateral orbital periosteum was preserved in all patients, which permitted cavity "mucosalization" within 8 weeks. Two patients are alive without disease at 15-month follow-up. One patient with persistent cavernous sinus malignant peripheral nerve sheath tumor died 4 months after resection despite proton beam therapy. CONCLUSION: This preliminary experience showed endoscopic power-assisted orbital exenteration to be an effective technique for exenteration of the orbit. Endoscopic power-assisted orbital exenteration offers two critical advantages: (1) direct transnasal control of the ophthalmic artery as it emerges from the optic foramen and (2) the ability to preserve the uninvolved superior and lateral periorbita. This can facilitate mucosal coverage of the exenterated space and obviate the need for tissue grafts and/or packing. Additionally, intraorbital pathology can be better visualized and blood loss and operative time are minimized. This technique may serve as an important adjunct for management of the orbit in patients with sinonasal malignancy or invasive fungal rhinosinusitis.

Adult↗

PubMedDate not supplied

Combined endoscopic trephination and endoscopic frontal sinusotomy for management of complex frontal sinus pathology.

BACKGROUND: The advances in endoscopic sinus surgery have revolutionized the management of frontal sinus disease. Despite the successes, the purely endoscopic approach has its limitations, especially in patients with alterations in anatomy caused by previous surgical intervention or complex frontal sinus pneumatization patterns. The purpose of this study was to evaluate the efficacy of combined endoscopic trephination and endoscopic frontal sinusotomy (the above and below approach) in the management of these difficult cases. METHODS: Chart review was performed on patients undergoing the combined approach from October 1999 to June 2004. Demographic data, symptomatology, comorbidity, previous surgery, and primary pathology were determined. Outcome was assessed based on subjective symptom relief and objective endoscopic patency. RESULTS: Twenty-two patients with a mean age of 49.2 years underwent the combined approach. The primary pathology included mucoceles (15 patients), frontal sinusitis (2 patients), inverted papilloma (2 patients), osteoma (1 patient), fibrous dysplasia (1 patient), and pneumocephalus (1 patient). A total of 25 above and below procedures (22 primary and 3 revision procedures) were performed to manage the pathology. Postoperatively, headaches resolved in 47%, improved in 35%, and remained unchanged in 18% of the patients. Orbital symptoms resolved in 63%, improved in 25%, and remained unchanged in 12% of the patients. Endoscopic patency of the frontal sinusotomy was confirmed in 19 of 22 cases (86%) at a mean follow-up of 16.2 months. CONCLUSION: Management of complex frontal sinus pathology may require adjunct approaches in conjunction to the standard endoscopic techniques. In this series, the above and below approach was used successfully in 22 patients. The combined approach may serve as an important adjunct for management of complex frontal sinus disease.

Adult↗

PubMedDate not supplied

Resection of anterior skull base tumors: comparison of combined traditional and endoscopic techniques.

BACKGROUND: Traditional craniofacial resection (tCFR) has been used successfully for resection of anterior skull base (ASB) tumors. Minimally invasive endoscopic resection (MIER) also has been used recently; this strategy facilitates superior visualization, avoids facial incisions, and preserves local structures. The goal of this study was to compare the outcome for these two approaches. METHODS: Retrospective chart analysis was conducted to identify patients undergoing resection of ASB tumors between January 1995 and January 2003. Demographic data, tumor characteristics, and the surgical approach used were determined. The mean operative time, estimated blood loss, hospital stay, and complications were analyzed. Recurrence and mortality rates were calculated. RESULTS: Nine patients were managed with the MIER approach, and 16 patients were treated with the traditional open approach. No significant difference was observed between groups on operative time, estimated blood loss, or hospital stay. Major complications were encountered in 2/9 (22%) and 7/16 (44%) patients in the MIER and tCFR groups, respectively. Recurrence was observed in 3/9 (33%) and 5/14 (36%) of the patients in the MIER and tCFR groups, respectively. Mortality rates in the MIER and tCFR groups were 0/9 (0%) and 4/15 (27%), respectively. CONCLUSION: In this preliminary study, MIER of ASB neoplasia did not differ significantly from tCFR in operative time, estimated blood loss, hospital stay, or complication rate. Survival and recurrence rates were similar also. This early experience suggests that MIER is a viable alternative for the surgical management of ASB lesions in appropriately selected patients.

Adult↗