C. Andrew van Hasselt

Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy

Objectives/Hypothesis Surgical excision is regarded as the treatment of choice for sinonasal inverted papilloma. Resection can be performed endoscopically or through an external approach. Debate exists about which approach to use. The study presents different endoscopic techniques for various tumor locations and reviews the results.

Dysphagia in treated nasopharyngeal cancer

To investigate the prevalence of long‐term dysphagia in patients treated for nasopharyngeal carcinoma (NPC) by radiotherapy.

Regulation of cell growth by estrogen signaling and potential targets in thyroid cancer.

Thyroid cancer occurs three times more frequently in females than in males, and in females the incidence decreases after menopause. This gender difference suggests that the growth and progression of thyroid cancer may be influenced by female sex hormones, particularly estrogens. Experimental data have clearly demonstrated that estrogens can influence cancer cell growth. The action of estrogens on target sites is mediated through related but distinct estrogen receptors, designated estrogen receptor alpha (ERalpha) and estrogen receptor beta (ERbeta), both of which are known to be expressed in thyroid cancer cells. The proliferation of thyroid cancer cells is promoted by an ERalpha agonist, whereas the proliferation is reduced by the enhanced expression of ERbeta or by an ERbeta agonist. When ERbeta is down-regulated, the proliferation of thyroid cells is significantly increased. Studies have shown that the expression of ERalpha in thyroid cancer cells is increased while the expression of ERbeta is either very low or absent. In conclusion, it appears that estrogens have opposite effects on the growth of thyroid cancer cells, depending on the balance between ERalpha and ERbeta in the cells. The modulation of ERalpha and ERbeta and the intervention of their pathways may open up new potential targets for the treatment of thyroid cancer.

Nasopharyngeal Carcinoma: Modes of Presentation:

Nasopharyngeal carcinoma (NPC) is a common malignancy among the southern Chinese people and has a poor prognosis. The aim of this study was to describe in detail the presentation of NPC as found between 1984 and 1988 at Prince of Wales Hospital, Hong Kong. Our study confirmed that patients present with an advanced stage of malignancy; 707% were stage III to V. Eighty-two percent of patients were between 21 and 60 years of age. The symptoms often suggested benign disease and most patients would delay seeking treatment for at least 5 months. We recommend inspection of the nasopharynx with flexible nasoendoscopy for all persons in high-risk areas on a regular basis and advise a policy of active health education for both physicians and the general population to reduce the stage of NPC at first presentation.

Gastroesophageal Reflux, Motility Disorders, and Psychological Profiles in the Etiology of Globus Pharyngis

The aim of this study was to investigate the origin of globus pharyngis with particular reference to esophageal disorders such as gastroesophageal reflux disease (GERD), motility disorders, structural abnormalities, other gastrointestinal tract diseases, and psychological profile. Previous studies on this subject using 24‐hour pH monitoring give conflicting results and are hampered by the high background prevalence of asymptomatic GERD in the normal Western population. The local Chinese population is known to have a very low background level of GERD and therefore is an ideal study population. Twenty‐six patients with globus pharyngis underwent 24‐hour ambulatory pH monitoring, esophageal manometry, and esophagogas‐troduodenoscopy with lower esophageal biopsy. A control group of 20 patients presenting with non‐ulcer dyspepsia was similarly investigated. Personality profiles of the globus pharyngis subjects and an appropriate control group were assessed. Eight of the globus pharyngis group (30.7%) had evidence of GERD, whereas only one of the controls (5%) demonstrated GERD on 24‐hour esophageal pH monitoring (P < 0.05). The manometric and personality profile studies did not show significant differences between study and control groups. We concluded that the finding of GERD in patients with globus pharyngis is not a coincidental finding but that there is a true association between GERD and globus pharyngis.

The Detection of the c-myc and ras Oncogenes in Nasopharyngeal Carcinoma by Immunohistochemistry

Forty-one paraffin embedded specimens of primary nasopharyngeal carcinoma (NPC) were examined to investigate the expression of c-myc and ras oncogenes. Sections were stained with the monoclonal antibodies myc 1-9E10 or ras Y13-259 and binding was detected using the ABC method. The intensity of staining for each tumour was assessed as nil, moderate or intense. The results indicated that 9 (22%) had intense staining for the c-myc oncogene, 28 (68%) had moderate staining and only 4 (10%) showed no staining. For the ras oncogene, 8 (19%) had intense staining, 22 (54%) moderate staining and 11 (27%) showed no staining. The patients clinical data indicated no correlation between the expression of either c-myc or ras p21 and age, sex, smoking, tumour stage, antibody titre to EBV, or family history. No correlation was found between ras p21 expression and survival; however, overexpression of the c-myc oncogene correlated with a poor prognosis (p < 0.05). This study is consistent with investigations demonstrating that c-myc expression correlates with poor survival in head and neck tumours.

A double-blind comparative study of ofloxacin otic drops versus neomycin-polymyxin B-hydrocortisone otic drops in the medical treatment of chronic suppurative otitis media

Active chronic suppurative otitis media poses a management problem when patients are being considered for surgical treatment. Topical antibiotics have demonstrated varying degrees of success in the management of discharging ears. The introduction of quinolones has revived interest in these topical agents. This double-blind study compares two antibiotics, namely ofloxacin and neomycin-polymyxin B, with similar in vitro sensitivities to Gram positive and Gram negative organisms. Fifty-two patients were selected randomly and the results show that ofloxacin eardrops have marginal benefits in symptomatic improvement (89 per cent versus 79 per cent, p = 0.27) and bacterial eradication (81 per cent versus 75 per cent, p = 0.81) in active chronic suppurative otitis media. Significantly fewer patients (seven per cent versus 29 per cent, p = 0.04) in the ofloxacin group had active disease at the end of the two-week treatment. We recommend the use of ofloxacin eardrops in managing active chronic suppurative otitis media since it has high clinical efficacy, contains no steroid component and has no demonstrated risk of ototoxicity.

Treatment results of sinonasal inverted papilloma: an 18-year study.

Background This article reviews our treatment results of sinonasal inverted papilloma (SNIP) over the past 18 years. A retrospective observational study was performed. Methods Fifty-six patients with SNIP seen between 1990 and 2008 with follow-up of >2 years were retrospectively analyzed. Results Forty patients (71%) had primary endoscopic resection and 16 patients (29%) had endoscopic-assisted external approaches. Ten patients (18%) had small nasoethmoid residual disease resectable under local anesthesia in the outpatient department. Eight patients (14%) had recurrences requiring revision under general anesthesia, most of which were maxillary and frontal disease requiring additional external approaches. Comparing patients with and without a history of previous surgery (36% versus 64% of all patients), the former had a higher chance of requiring external approaches during the primary resection (45% versus 29%), a higher recurrence rate (45% versus 25%), and a higher chance of external approaches for revision (44% versus 22%). All the first recurrences were at the original tumor site. Eighty-nine percent of the first recurrences were diagnosed within the first 2 years postoperation. Conclusion Thirty-two percent of our patients had recurrence after their primary resection. Recurrences in the nasoethmoid area are usually small and resectable endoscopically under local anesthesia in the outpatient department whereas those inside the maxillary and frontal sinuses are likely to require additional external approaches under general anesthesia. A minimum of 2 years of follow-up is recommended for the preliminary report on the treatment results of this condition. Lifelong follow-up is recommended for possible late recurrences and metachronous multifocal disease.

Sensitivity and specificity of Epstein-Barr virus IgA titer in the diagnosis of nasopharyngeal carcinoma: A three-year institutional review

IgA antibody titers to the Epstein‐Barr virus (EBV) viral capsid antigen (EBV IgA‐VCA) and to the EBV early antigen (EBV IgA‐EA) are used to screen for nasopharyngeal carcinoma (NPC). This study evaluates the sensitivity and specificity of EBV IgA‐VCA and EBV IgA‐EA titers in screening patients for NPC and in those diagnosed with NPC at our institution.

Prevalence and prognostic significance of tumor-associated tissue eosinophilia in nasopharyngeal carcinoma

Tumor‐associated tissue eosinophilia (TATE) has been associated with an improved prognosis in a variety of neoplasms.