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Biomedical subjects

V J Lund

Publications and source records attributed to V J Lund.

At least 19 recordsLinked to original sources
PubMed2001

Evidence-based surgery in chronic rhinosinusitis.

Considerable interest has been focused in recent years on an evidence-based approach to clinical medicine. For obvious reasons, however, it has proved difficult to examine the benefit of surgical procedures in randomized, double-blind. placebo-controlled trials. This review considers the evidence available in the literature for surgery in chronic rhinosinusitis and examines the validity of the studies in the context of evidence-based medicine.

Chronic Disease↗
PubMed2001

A case of rhinoscleroma treated with ciprofloxacin.

Respiratory scleroma (often termed 'rhinoscleroma') is a chronic inflammatory condition in which deforming masses of tissue distend the nasal cavity. Klebsiella rhinoscleromatis is the causative agent of this infection and the Mikulicz cell is specific to the lesion being a large macrophage with clear cytoplasm containing the bacilli. Antibiotic therapy has traditionally consisted of streptomycin and tetracycline long-term but this presents problems with adverse side-effects and poor patient compliance. We report on a young patient with nasal rhinoscleroma who achieved resolution after treatment with oral ciprofloxacin. As mentioned in a review of patients with rhinoscleroma at the Mayo clinic in 1993, the fluoroquinolones deserve further study as potentially highly effective agents for this condition. Ciprofloxacin is convenient for oral administration and has few adverse effects. It achieves good tissue penetration, is concentrated in macrophages and may prove to be useful in the therapy of rhinoscleroma.

Adolescent↗
PubMed2001

The effect of laser assisted uvulopalatoplasty on the sense of smell and taste.

AIM: To assess the effect, if any, of Laser Assisted Uvulo Palatoplasty (LAUP) on the sense of smell and taste. MATERIALS AND METHODS: A prospective study examined 33 patients undergoing LAUP for snoring. Significant sinonasal pathology was excluded in all patients by a complete examination including rigid nasal endoscopy. None of the cases had any systemic illness or drug history that was likely to affect the sense of smell or taste. Twenty-eight patients were male and five female. The mean age was 44 years (range, 25-67). Twelve patients (36%) were regular smokers, and eight patients (24%) were ex-smokers all of whom reported a change in smell and taste after stopping. Preoperative assessment utilised a visual analogue score of smell and taste perception, the University of Pennsylvania Smell Identification Test (UPSIT) for the assessment of olfaction (maximum score of 40), and whole mouth testing for solutions of NaCl, sucrose, quinine, citric acid and acetic acid. LAUP technique was standardised for each case and reassessment was performed 3 months postoperatively. RESULTS: Three patients failed to complete the study and were excluded. The mean values for visual analogue score pre and post surgery were 9.1 and 8.9 respectively, which was not significant using Wilcoxon Rank test (P = 0.257). The mean value of the UPSIT scores before surgery were 32.3 (+4.0), range, 24-39, and after surgery 31.2 (+4.3), range 20-37. There was no significant difference in pre and post UPSIT scores (p = 0.068). Whole mouth taste testing had a preoperative mean value of 4.1 and a postoperative value of 4.2. The difference was not statistically significant, Wilcoxon Rank test (p = 0.317). CONCLUSION: In this study there was no significant change in the patients' perception of smell and taste or in their objective measurement following a standardised Laser Assisted Uvulopalatoplasty.

Adult↗
PubMed2001

Health related quality of life in sinonasal disease.

Objective measurements of sinonasal disease have proved difficult to standardise and correlate poorly with the severity of symptoms. Quality of life, which has been defined as the gap between expectation and experience allows the impact of disease to be quantified thus enabling comparison of different diseases and enabling examination of therapeutic response. A range of generic and disease specific questionnaires have been developed of varying complexity. These have been applied to a range of sinonasal conditions including allergy, infection and neoplasia. With increasing refinement they may become the main primary outcome measures in both clinical trials and practice.

Health Status Indicators↗
PubMed2000

Acetochlor-induced rat nasal tumors: further studies on the mode of action and relevance to humans.

The herbicide acetochlor, and its analogue alachlor, have similar toxicological properties, the most significant being the induction of nasal adenomas in rats in 2-year feeding studies. Previous investigations have proposed a mode of action involving metabolism to a quinone-imine, the formation of protein adducts, cell death, and compensatory hyperplasia leading to the observed adenomas. Comparisons between rats and humans of the metabolic cascade leading to the quinone-imine indicate that these chemicals do not pose a threat to humans. Further investigations with acetochlor, presented here, have revealed an additional activation pathway in which a sulfoxide metabolite of acetochlor plays a key role. The sulfoxide was found to be the major plasma metabolite in rats dosed with acetochlor. Whole-body autoradiography studies established that this metabolite selectively accumulates and persists in the olfactory epithelium of rats. Radiolabeling of the sulfoxide molecule in the phenyl ring and in the sulfoxide side-chain demonstrated that the metabolite accumulating in nasal tissues retains the sulfoxide side-chain. The formation of a quinone-imine from the sulfoxide was facilitated by hydroxylation of the phenyl ring by a cytochrome P450 isoenzyme which was specific to the nasal epithelium in the rat. This metabolic conversion could not be detected in 33 fresh human nasal tissue samples, supporting the earlier view that the acetochlor-induced rat nasal tumors do not represent a hazard for humans.

Adenoma↗
PubMed2000

Detection of fungi in sinus fluid of patients with allergic fungal rhinosinusitis.

We aim to develop a rapid, accurate and sensitive diagnostic assay with which to detect the surface antigens of fungi thought to be involved in allergic fungal rhinosinusitis (AFRS), by assessing the usefulness of immunofluorescence microscopy (IMF) and enzyme linked immuno-absorbent assays (ELISA). The age, sex, clinical symptoms and signs, imaging (CT and/or MRI), microbiological subculture data, sinus contents, blood eosinophilia, aspergillosis precipitins, radioallergoabsorbent technology (RAST) for fungal allergens and histopathology were performed on individuals undergoing endoscopic sinus surgery for suspected AFRS. Thirteen patients were examined, and five monoclonal antibodies raised to the surface washings of various fungi were found to recognize and differentiate between fungal species implicated in sinus disease, i.e. Aspergillus niger, Alternaria alternata, Cochliobolus lunata, Penicillium expansum and Cladosporium species. The IMF microscopy proved to be a useful assay to distinguish visually between the cultured fungi, but was less useful for visualization of fungi in the patient samples. However, ELISA assays with 5 monoclonal antibodies gave clear and unambiguous data as to the presence of certain fungi within the patient samples. There is good correlation between the ELISA data and the pathology findings. This preliminary study suggests that both IMF and ELISA techniques may offer an important advance in this area.

Adolescent↗
PubMed2000

Fungal rhinosinusitis.

Fungal infections in both their invasive and non-invasive forms can prove difficult to diagnose. The often characteristic appearances on imaging are of great assistance. CT is the primary imaging modality and is probably more accurate than MRI in diagnostic specificity and determining the extent of bone erosion. However this may require a modified scanning technique to adequately demonstrate the typical soft tissue density variations of fungi. MRI should be used to supplement CT when intra-cranial or intra-orbital extension is suspected.

Humans↗
PubMed2000

Optimum imaging for inverted papilloma.

Inverted papilloma is the most common benign tumour of the nose and paranasal sinuses, and usually arises in the lateral wall of the nasal cavity and the middle meatus. The diagnosis is suggested on computed tomography (CT) when there is a mass continuous from the middle meatus into the adjacent maxillary antrum, through an expanded maxillary ostium. The mass may contain areas of high density or calcification, and there may be sclerosis of the wall of the affected sinus. The main advantage of magnetic resonance imaging (MRI) is in defining the extent of the tumour, and in differentiating it from adjacent inflammatory tissue, but there are no certain signal intensity or enhancement characteristics to help differentiate inverted papilloma from sinus malignancy. In the differential diagnosis, antro-choanal polyp, malignant sinus tumours and chronic rhinosinusitis and fungal disease need to be excluded. The combination of bone deformity and sclerosis with the typical antro-meatal mass suggests a slow-growing tumour such as inverted papilloma.

Adult↗
PubMed2000

Optimum imaging and diagnosis of cerebrospinal fluid rhinorrhoea.

Imaging is an important component in the investigation of unilateral watery rhinorrhoea suspicious of cerebrospinal fluid (CSF). Whilst the demonstration of the presence of beta 2 transferrin confirms that CSF is present it may prove difficult to demonstrate the exact site of origin. Fine detail coronal computed tomography (CT) with sections of 1-2 mm thickness through the anterior skull base may show small dehiscences and fractures. The commonest site for congenital dehiscences is the cribriform niche adjacent to the vertical attachment of the middle turbinate anteriorly and the superior and lateral walls of the sphenoid posteriorly. In the presence of frequent or constant CSF rhinorrhoea a CT cisternogram can be helpful in defining the exact site of the leak. Magnetic resonance imaging (MRI) is reserved for defining the nature of soft tissue i.e. inflammatory tissue, meningoencephalocele or tumour. Finally, per-operative intrathecal fluorescein is helpful when imaging does not prove positive. A management algorithm for CSF rhinorrhoea is presented.

Adolescent↗
PubMed2000

Optimum imaging for mucoceles.

A mucocele is an epithelial lined mucus-containing sac completely filling a paranasal sinus and capable of expansion. They are relatively unusual, occurring most frequently in the fronto-ethmoidal region. The imaging features on plain X-ray, computerized tomography and magnetic resonance imaging are relatively characteristic allowing distinction of the lesion from other pathologies in this area although the mucoceles may occur in association with other pathologies such as nasal polyposis and neoplasia.

Ethmoid Sinus↗
PubMed2000

Optimum management of inverted papilloma.

Surgery offers the optimum modality of treatment for inverted papilloma although a considerable range of operative approaches have been described. The results are presented in a cohort of 37 cases treated by both endoscopic and combined endoscopic and external approaches with a recurrence rate of eight and 21 per cent respectively. This series is compared with those in the literature and demonstrates that it is extent of disease which primarily determines the choice of surgical approach, with previous treatment, individual patient factors and surgical expertise as secondary determinants.

Adult↗
PubMed2000

Imaging for endoscopic sinus surgery in adults.

Computerized tomography (CT) offers the gold standard in terms of imaging the extent of disease and the fine detailed anatomy, both pre-requisites to the safe practice of endoscopic sinus surgery. Neither plain X-rays nor magnetic resonance imaging (MRI) offer optimal information in this respect. A variety of protocols minimizing radiation dose to the lens whilst providing high quality images are presented together with a menu of anatomical features that require careful evaluation pre-operatively.

Adult↗
PubMed2000

Optimum imaging for sinonasal malignancy.

A combination of computed tomography (CT) and magnetic resonance imaging (MRI) is now established as the optimum assessment of sinonasal malignancy. CT and MRI are of particular value in assessing the skull base, orbit and pteryo-palatine and infratemporal fossae. Although MRI offers better differentiation of tumour from surrounding tissue and fluid, coronal CT is still required for the demonstration of bone erosion particularly in the region of the cribriform plate. Thus the extent of local tumour spread may be determined with a degree of accuracy in excess of 98 per cent. However, the final determinant of penetration of the dura and orbital periosteum requires per-operative frozen section assessment. A knowledge of the tissue characteristics and site of origin can be of value in distinguishing some of the commoner sinonasal malignancies such as squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, olfactory neuroblastoma and chondrosarcoma. Imaging, particularly MRI also plays an important role in the post-therapeutic follow-up of patients, indicating areas of residual or recurrent disease, defining suspicious areas for biopsy. Post-operative surveillance is best achieved with three planar T1-weighted MRI, with, and without, gadolinium and axial T2-weighted sequences. The subtraction of the T1 pre- and post gadolinium T1 sequences can be of particular value in delineating recurrence.

Chondrosarcoma↗
PubMed2000

Imaging for juvenile angiofibroma.

Juvenile angiofibroma presents characteristic imaging signs, may of which allow diagnosis and accurate estimation of extent without recourse to the dangers of biopsy. The diagnosis by computed tomography (CT) is based upon the site of origin of the lesion in the pterygopalatine fossa. There are two constant features: (1) a mass in the posterior nasal cavity and pterygopalatine fossa; (2) erosion of bone behind the sphenopalatine foramen with extension to the upper medial pterygoid plate. Good bone imaging on CT is essential to show invasion of the cancellous bone of the sphenoid. This is the main predictor of recurrence: the deeper the extension, the larger the potential tumour remnant likely to be left following surgery. The characteristic features on magnetic resonance imaging (MRI) are due to the high vascularity of the tumour causing signal voids and strong post-contrast enhancement. MRI shows the pre-operative soft tissue extent of angiofibroma optimally, but its more important application is to provide post-operative surveillance: to show any residual or recurrent tumour, record tumour growth or natural involution and monitor the effects of radiotherapy.

Adolescent↗
PubMed1999

Endoscopic drainage of pediatric paranasal sinus mucoceles.

Paranasal sinus mucoceles are rare in children. The traditional treatment is to perform surgical drainage via an external incision. In adults endonasal surgical techniques are increasingly being used to treat mucoceles. A series of seven children is reported. All cases were successfully treated with endoscopic intranasal surgical drainage without complication or recurrence. When used by surgeons familiar with endoscopic sinus surgery this has proved a safe and successful procedure that avoids facial scarring. Despite previous reports suggesting cystic fibrosis is the major aetiological factor in pediatric mucoceles, no child in this series had been diagnosed as suffering from cystic fibrosis.

Child↗
PubMed1999

The role of midfacial degloving in modern rhinological practice.

The midfacial degloving approach has been available for twenty five years and is slowly increasing in popularity in the management of extensive benign lesions of the sinonasal region, for selected malignancy in this area and to afford access to the nasopharynx and infra-temporal fossa. The advantages, applications and low complication rate are presented in a cohort of 86 patients, ranging from three to 79 years of age with a mean follow-up of 5.5 years. Seventy-seven per cent of the group had benign pathology of which juvenile angiofibroma was the commonest (40 cases). The 20 cases of malignant disease were a heterogeneous group histopathologically including adenoid cystic carcinoma (four cases), malignant schwannoma (two cases), rhabdomyosarcoma (two cases) and squamous cell carcinoma (two cases). Five underwent bilateral radical maxillectomies combined with orbital clearance in one patient. Complications include oro-antral fistula (three cases) and epiphora (three cases) all of which were successfully treated.

Adenoids↗