Mark H. Tabor

Single-marker identification of head and neck squamous cell carcinoma cancer stem cells with aldehyde dehydrogenase

In accord with the cancer stem cell (CSC) theory, only a small subset of cancer cells are capable of forming tumors. We previously reported that CD44 isolates tumorigenic cells from head and neck squamous cell cancer (HNSCC). Recent studies indicate that aldehyde dehydrogenase (ALDH) activity may represent a more specific marker of CSCs.

Head and neck cancer stem cells: The side population†

The cancer stem cell (CSC) theory concludes that a subpopulation of cancer cells, the cancer stem cells, can self‐renew and are responsible for tumor growth. Previous studies have identified cells able to efflux Hoechst 33342 dye as the side population (SP). SP cells and CSCs share many characteristics, suggesting the SP isolated from malignant tumors contains CSCs.

Probiotics as adjunctive treatment for chronic rhinosinusitis: a randomized controlled trial.

Objective: To determine if oral probiotics as adjunctive treatment are more effective than placebo in improving quality of life in patients with chronic inflammatory rhinosinusitis. Design: Prospective, randomized, double-blind, placebo-controlled trial. Methods: A total of 77 patients with chronic inflammatory rhinosinusitis were randomly assigned to receive oral probiotic Lactobacillus rhamnosus R0011 strain (500 million active cells/tablet twice daily) (n = 39) or oral placebo treatment (n = 38) for 4 weeks. Results: In the probiotic group, the mean change from baseline in the SNOT-20 scores was significant at 4 weeks (P = 0.002) but not at 8 weeks (P = 0.37). Rhinological domain improved by 9.3 percent (P = 0.004) in probiotics group but returned to baseline level at 8 weeks. No significant differences were found between the probiotic and placebo groups in mean changes from baseline to 4 weeks (P = 0.79) or from baseline to 8 weeks (P = 0.23). No changes in symptom frequency were noted, either within each group or between treatment groups at 4 and 8 weeks. There was no difference in medication use or side effects between the two study groups. Conclusion: Oral use of the probiotic strain L rhamnosus R0011 did not improve sinonasal quality-of-life scores in patients with chronic inflammatory rhinosinusitis compared with placebo.

Field of view comparison between two-dimensional and three-dimensional endoscopy

Relative to microscopic transnasal surgery, endoscopic surgery provides improved visualization with an increased field of view. Advances such as high‐definition (HD) and three‐dimensional (3D) endoscopy have been introduced and clearly improve visualization. However, do both technologies maintain an increased field of view? We hypothesize that the field of view of 3D endoscopy is restricted relative to two‐dimensional (2D) HD endoscopy.

Polyethylene glycol (PEG) hydrogel dural sealant and collagen dural graft matrix in transsphenoidal pituitary surgery for prevention of postoperative cerebrospinal fluid leaks

Cerebrospinal fluid (CSF) rhinorrhea is the most common complication after transsphenoidal pituitary surgery. The authors compare their previous experience using an autologous fat graft and lumbar drain placement in 107 patients with their current technique of using a dural sealant and collagen matrix in 97 patients to prevent postoperative CSF leak after pituitary tumor resection. The failure rate for CSF leak repairs between the two groups was similar. The use of a dural sealant and collagen matrix, however, has the advantages of decreased length of hospital stay, decreased length of Intensive Care Unit stay, avoidance of the morbidity of an extra abdominal incision, and avoidance of the risks of lumbar CSF drainage.

The use of narrow band imaging in patients with benign disease: hereditary hemorrhagic telangiectasia.

SUMMARY : Narrow band imaging (NBI) is a new type of imaging technology that enhances the visibility of blood vessels used in the detection of abnormal angiogenesis in preneoplastic and neoplastic lesions. This technique is used in the diagnosis and management of dysplastic and malignant endobronchial lesions. To our knowledge, this is the first description of the use of NBI to diagnose and manage benign lesions, hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to implement NBI as a tool for use in the bronchoscopic visualization leading to the diagnosis and management of nonmalignant lesions in the tracheobronchial tree. This is including but not limited to HHT. NBI was used to detect the origin of significant hemoptysis in a patient with HHT. The patient had conventional white light (CWL) bronchoscopy, followed by NBI. NBI illuminated the abnormal blood vessels significantly better than CWL bronchoscopy. This led to a more effective diagnosis and management of the abnormal vessels causing the hemoptysis. NBI may provide a higher probability of locating abnormal endobronchial lesions in both benign and malignant diseases than CWL bronchoscopy. It can be used to treat these abnormal lesions as in our patient who presented with hemoptysis. A prospective study is needed to determine whether NMI and CWL are additive as in malignant disease. Furthermore, NBI can be used in lesions of the tracheobronchial tree and the gastrointestinal tract, and pleura, so that the appropriate management can be initiated.

Endoscopic Corneal Neurotization: Technique and Initial Experience

PURPOSE The authors describe a minimally invasive surgical technique to re-establish corneal sensibility in a patient with neurotrophic keratopathy with the supraorbital nerve harvested endoscopically. METHODS Pedicled contralateral supraorbital nerve was harvested endoscopically through small eyelid crease and scalp incisions and transferred to the affected eye. RESULTS Endoscopic corneal neurotization was successfully performed with restoration of corneal sensibility and corneal epithelial integrity. CONCLUSIONS The use of an endoscope allows for a minimally invasive approach to successful corneal neurotization with the supraorbital nerve.

Pneumatization Patterns of the Petrous Apex and Lateral Sphenoid Recess

Introduction The petrous apex poses a challenge for surgical intervention due to poor access. As intraoperative image guidance and surgical instrumentation improve, newer endoscopic approaches are increasingly favored. This study aims to provide normative data on the anatomy of the lateral sphenoid sinus recess and petrous apex. These normative data could assist in determining the efficacy of a transnasal transsphenoidal approach to lesions of the anteroinferior petrous apex. Methods This is a retrospective study investigating normative data on all maxillofacial computed tomography (CT) scans performed at a level I trauma center over a 6‐month period. All appropriate images had the pneumatization pattern of the petrous apex and lateral recess of the sphenoid sinus reviewed by a single otologist and graded bilaterally. These were then analyzed in SPSS; Pearson correlation analyses and χ2 test were used. Results A total of 481 patients were identified, yielding a total of 962 temporal bones and sphenoid sinuses for analysis. Eighty‐eight percent of sides analyzed had a nonpneumatized lateral recess. The petrous apex was nonpneumatized in 54% of sides analyzed. There was a correlation noted between the degree of pneumatization of the petrous apex and pneumatization of the lateral recess of the sphenoid. Conclusion This study is the first to provide normative data comparing pneumatization of the petrous apex and sphenoid sinus. These data may support future work evaluating the utility of an endonasal approach to the petrous apex.

Endoscopic endonasal resection of a medullary cavernoma: a novel case

Abstract Brainstem cavernomas can present very challenging operative problems. Endoscopic endonasal approaches to these lesions in the mesencephalon and pons have been described. In this article the authors present the first case of a medullary cavernoma resected by an endoscopic transclival approach. A 26 year-old woman with a 1.5 cm medullary cavernoma presented with imbalance, swallowing difficulty, and right hemibody weakness. She was taken to the operating room for endoscopic endonasal transclival resection. Her pre-existing neurologic deficits worsened initially after surgery, but at three-month follow-up she had made a full neurologic recovery.

Rhinosinusitis in the Immunocompromised Cancer Population

Objective: The microbiology of acute and chronic sinusitis in the general population is well documented, however, this is not well characterized in vulnerable subgroups. Our primary aim is to evaluate the paranasal sinus microbiology of immunocompromised patients at a tertiary cancer center. Method: Following institutional review board approval, records at Moffitt Cancer Center were retrospectively reviewed using ICD-9 codes for in-hospital treatment of sinusitis while undergoing concurrent oncologic therapy. All patients had nasal endoscopy with aerobic middle meatal culture. Demographics, type of malignancy, leukocyte count, glycemic status, and culture results were recorded. Results: Eighty patients were identified from June 2000 to April 2009. Malignancies included leukemia (63%), lymphoma (22%), multiple myeloma (5%), carcinoma (5%), and sarcoma (4%). One patient (1%) had common variable immunodeficiency. A total of 102 sinus cultures were collected. Of those, 59 (58%) were interpreted as no growth (n = 20) or usual respiratory flora (n = 39). Of the 46 positive cultures, 58 organisms were isolated. There were 16 fungi (28%), 12 coagulase-negative Staphylococcus (20%), 9 methicillin-sensitive Staphylococcus aureus (16%), 8 methicillin-resistant Staphylococcus aureus (14%), 6 Pseudomonas species (10%), 3 Moraxella catarrhalis (5%), and 4 other gram-negative bacilli (7%) isolated. Conclusion: Pathogens identified in this population differ from published data examining the general population. There is an increased percentage of negative cultures, fungi and coagulase negative staphylococcus. We found fewer streptococcus pneumonia species. We attribute this change in flora to frequent empiric treatment of this population with broad-spectrum antibiotics.