Arthur W. Wu

Chronic rhinosinusitis in children: what are the treatment options?

Pediatric chronic rhinosinusitis, a common problem, has been found to have a severe impact on the quality of life. As in the case with adult chronic rhinosinusitis, pediatric chronic rhinosinusitis is difficult to treat, with resultant frequent recurrences and failures. Controversy has existed in the treatment of chronic rhinosinusitis in children, mirroring the controversy over the exact etiology of this disorder. Chronic rhinosinusitis may indeed be a group of diseases with similar presenting features. This article attempts to delineate treatment options that are both safe and effective for pediatric chronic rhinosinusitis.

Diagnosis and endoscopic management of sinonasal schwannomas.

Aims: Survey the clinical symptoms, radiological features, management, and long-term outcomes of sinonasal and anterior skull base schwannomas. Patients and Methods: Retrospective review of patients with sinonasal schwannomas treated from June 2001 through January 2010 at two academic institutions. Results: There were 4 women and 3 men in this study. The mean age was 46 years (range 17–68). The mean tumor size was 2.4 cm (range 1.4–3.8 cm). Tumor locations included ethmoid sinuses (3), nasal cavity (2) and pterygopalatine fossa (2). Six patients had endoscopic resections, while 1 was approached and resected via a lateral rhinotomy. The mean follow-up was 2.8 years. There were no tumor recurrences during the study period. Conclusions: Schwannomas of the paranasal sinuses and nasal cavity are uncommon tumors that can usually present with vague and nonspecific symptoms. Magnetic resonance imaging can suggest the diagnosis; however, a definitive diagnosis is made by correlation with histopathological findings. Treatment is complete surgical resection. This study illustrates the effectiveness of the endoscopic endonasal approach in the treatment of these benign tumors.

Invasive sinonasal actinomycosis: case report and literature review.

Actinomycosis is a rare anaerobic bacterial infection typically caused by Actinomyces israelii. Although part of normal flora in the oral cavity, and respiratory and digestive tracts, A israelii can give rise to pathologic infections most commonly reported in the oral cavity from odontogenic causes. We present a rare case of invasive actinomycosis presenting with extensive midface destruction involving the maxilla and paranasal sinuses, with mucosal necrosis mimicking an aggressive neoplasm. The diagnosis is usually reached only after histopathologic analysis showing characteristic sulfur granules with filamentous gram‐positive, non–acid‐fast bacteria. We review the literature on its epidemiology, clinical presentation, diagnosis, treatment, and prognosis.

Surgical Practice Patterns in the Treatment of Papillary Thyroid Microcarcinoma

BACKGROUND recently, there has been a debate regarding total thyroidectomy vs hemithyroidectomy for papillary thyroid microcarcinoma (PTMC). OBJECTIVE to determine whether there were significant differences in the treatment of PTMC depending on a physicians experience, age, training, and location. METHODS a 10-question survey was distributed to otolaryngologists, general surgeons, and endocrine surgeons. It included 4 clinical scenarios, 2 questions querying clinical reasoning, and 4 demographic questions (training, surgical volume, location, and age). The demographic variables were used to analyze responses to the 4 clinical scenarios with bivariate and multivariate statistics. RESULTS a total of 438 responders completed the survey. Given a single subcentimeter PTMC, 70.3% of surgeons recommended no further surgery after a hemithyroidectomy, yet 29.7% believed that completion thyroidectomy was necessary. Otolaryngologists chose total thyroidectomy more frequently, as did surgeons from the South and West. Given PTMC with lymphatic invasion, 392 (89.5%) responders recommended completion thyroidectomy, with otolaryngologists again more inclined toward completion surgery. Given multifocal PTMC, 85.4% chose completion thyroidectomy, with surgeons in the South and West recommending total thyroidectomy more frequently compared with those in the Northeast. Improved survival, surgeon preference, and need for thyroid suppression were rated relatively insignificant. Ease of patient follow-up and multifocality of disease were judged very significant. Influence from national guidelines and current literature was rated as only somewhat or minimally significant. CONCLUSIONS in this survey, most surgeons seemed to follow national guidelines regarding the surgical treatment of PTMC. However, significant differences in the treatment and perception of PTMC exist based on surgical training and location.

What is the best treatment for papillary thyroid microcarcinoma

BACKGROUND There has been substantial recent debate over the best surgical treatment for papillary thyroid microcarcinoma (PTMC), defined as a carcinoma less than 1 cm in size. As the incidence of patients with these subcentimeter tumors increases, the question of whether to peform a total versus a hemithyroidectomy for these lesions has become increasingly important. Historically, treatment of any thyroid malignancy entailed total thyroidectomy both for eliminating tumor surgically and for clearing normal thyroid tissue prior to postoperative radioactive iodine ablation. This paradigm has slowly shifted with recent guidelines put forth by the American Thyroid Association in 2009 espousing conservative management of PTMC with hemithyroidectomy alone. However, as demonstrated by a recent survey study by these authors, clinical practice in the surgical community is more mixed with a significant minority of surgeons (30%) believing total thyroidectomy to be the appropriate treatment.

Abstract 3316: CD44High head and neck cancer cells demonstrate increased cell growth and chemotherapeutic resistance

Proceedings: AACR 101st Annual Meeting 2010‐‐ Apr 17‐21, 2010; Washington, DC Background: Head and Neck Squamous Cell Carcinoma (HNSCC) is a tumor made up of a heterogeneous population of cancer cells. Differences in individual cell phenotype may extrapolate to clinical behavior at the tumor level. CD44 is a cell surface marker highly expressed in putative cancer stem cells. Here, we demonstrate that fluorescence activated cell sorting (FACS) for the CD44 cell surface marker isolates a population of HNSCC cells with increased growth rate, colony forming ability, and chemoresistance. Methods: FACS was used to isolate CD44High and CD44Low cells from the HNSCC cell line SCC1. CD44High, CD44Low and unsorted cells were compared with respect to cell growth using the MTT assay for 8 days. They were also seeded into agar and grown for 6 weeks to determine colony forming potential. Sorted and unsorted cells were also compared for their sensitivity to cisplatin (20 µM). Live cells were measured using the MTT assay and compared to untreated cells at the same time point in order to calculate relative growth rates. Additionally, SCC1 cells were analyzed using FACS with and without cisplatin to determine changes in the population of CD44High cells. Primary tumor specimens and normal controls were analyzed for various cancer stem cell markers via immunohistochemistry. Results: CD44High SCC1 cells grew the fastest in culture with CD44Low cells growing significantly slower. Unsorted cells had a similar growth rate to CD44High cells, which is not surprising given that CD44High cells made up roughly 60% of the total population. CD44High cells in soft agar developed significantly more colonies with a larger average colony size after 6 weeks in culture compared to unsorted and CD44Low cells. CD44High SCC1 cells also were less sensitive to cisplatin with no difference in cell growth between treated and untreated cells. Using FACS to analyze unsorted cells after treatment with cisplatin, we observed enrichment in the CD44High cell population. Control non-cancer specimens demonstrated expression of p16 with low levels of BMI and CD44 on immunohistochemical analysis. Poorly differentiated HNSCC tumors demonstrated absence of p16, high BMI, and high CD44. Conclusion: The cell surface marker CD44 is expressed in a subset of HNSCC cells that have higher growth rates, tumorogenicity, and resistance to chemotherapy. These HNSCC stem cells may be the reason for resistance and recurrence. Understanding the mechanism behind their specific phenotype will be valuable in advancing treatments for HNSCC. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3316.

Acute Sinusitis Following Endoscopic Skull Base Surgery

OBJECTIVE: Endonasal surgery of the cranial base requires extensive training in anatomy and endoscopic techniques. A training model for simulation of endoscopic surgery of the paranasal sinuses and cranial base was developed that 1) replicates the surgical experience and 2) provides a measurable learning curve. METHOD: The anatomical model is generated from CT data and has bone generated from a 3D printer and silicone applied to recreate nasal soft tissue. Design requirements were surgical simulation with real surgical instruments and the objective detection of injured structures at risk (orbit, dura, internal carotid artery, and optic nerve). RESULTS: Using this teaching model, it is possible to demonstrate a learning curve and track the progress of a surgeon (duration of surgery, number and location of injuries). Anatomical and pathological variations can be introduced to provide a varied surgical experience. CONCLUSION: This model replicates the surgical experience and allows the surgeon to monitor the learning curve. The use of actual surgical instruments provides realistic haptic feedback. Future trials will demonstrate the contribution of surgical simulation on surgical proficiency in the operating room.