Wouter Bauters

Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma.

BACKGROUND Adult patients with nasal polyps often have comorbid asthma, adding to the serious effect on the quality of life of these patients. Nasal polyps and asthma might represent a therapeutic challenge; inflammation in both diseases shares many features, such as airway eosinophilia, local IgE formation, and a T(H)2 cytokine profile. Omalizumab is a human anti-IgE mAb with proved efficacy in patients with severe allergic asthma. Omalizumab could be a treatment option for patients with nasal polyps and asthma. OBJECTIVE The goal of this study was to investigate the clinical efficacy of omalizumab in patients with nasal polyps and comorbid asthma. METHODS A randomized, double-blind, placebo-controlled study of allergic and nonallergic patients with nasal polyps and comorbid asthma (n = 24) was conducted. Subjects received 4 to 8 (subcutaneous) doses of omalizumab (n = 16) or placebo (n = 8). The primary end point was reduction in total nasal endoscopic polyp scores after 16 weeks. Secondary end points included a change in sinus computed tomographic scans, nasal and asthma symptoms, results of validated questionnaires (Short-Form Health Questionnaire, 31-item Rhinosinusitis Outcome Measuring Instrument, and Asthma Quality of Life Questionnaire), and serum/nasal secretion biomarker levels. RESULTS There was a significant decrease in total nasal endoscopic polyp scores after 16 weeks in the omalizumab-treated group (-2.67, P = .001), which was confirmed by means of computed tomographic scanning (Lund-Mackay score). Omalizumab had a beneficial effect on airway symptoms (nasal congestion, anterior rhinorrhea, loss of sense of smell, wheezing, and dyspnea) and on quality-of-life scores, irrespective of the presence of allergy. CONCLUSION Omalizumab demonstrated clinical efficacy in the treatment of nasal polyps with comorbid asthma, supporting the importance and functionality of local IgE formation in the airways.

Increased Levator Muscle Function by Supramaximal Resection in Patients With Blepharophimosis-Ptosis–Epicanthus Inversus Syndrome

OBJECTIVE To study the efficacy and clinical and anatomical results of supramaximal levator resection in patients with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) with severe congenital ptosis with poor levator function (LF). METHODS Eleven patients with molecularly proven BPES underwent supramaximal levator resection. Palpebral fissure height and LF were measured preoperatively and postoperatively. RESULTS All patients showed an excellent reduction in ptosis with a single intervention resulting in a clear visual axis. Palpebral fissure height improved from mean (SD) 3.3 (0.7) mm preoperatively to 7.1 (0.9) mm postoperatively (P value <.001). Four patients underwent additional surgery because of cosmetic issues with eyelid height asymmetry. All patients showed a marked, consistent, and lasting improvement in LF, going from mean (SD) 1.9 (0.9) mm preoperatively to 7.4 (1.1) mm postoperatively (P value <.001). This improvement could be attributed to the presence of a very long and thin tendon, as well as a striated muscle belly. This elongated aponeurosis inhibits the levator muscle from having sufficient impact on the vertical eyelid excursion. CONCLUSIONS We demonstrated that supramaximal levator resection performed in patients with BPES not only results in good cosmetic appearance in terms of ptosis reduction in the majority of cases but also in a significant increase of the levator palpebrae superioris function. An anatomical substrate was found to explain these findings. To our knowledge, this is the first study to provide evidence of a marked increase in LF in BPES due to resection of the elongated tendon with reinsertion of the muscle belly.

Evaluation of metastatic lymph nodes in head and neck cancer : A comparative study between palpation, ultrasonography, ultrasound-guided fine needle aspiration cytology and computed tomography

Abstract Study design. In head and neck cancer patients, diagnosis of metastatic lymph nodes of the neck is essential for treatment planning and prognosis assessment. In a retrospective study, we compared palpation, ultrasonography, ultrasound-guided fine needle aspiration and computed tomography in patients with head and neck cancer. Methods. Results of palpation, ultrasonography and computed tomography were available in 78 out of 110 patients diagnosed with head and neck cancer. Ultrasound-guided fine needle aspiration cytology was performed in 26 of these patients. Patients with suspected lymph node(s) observed in one or more techniques underwent neck dissection. Results. Twenty seven patients underwent neck dissection, studying 150 lymph node regions. The sensitivity, specificity, positive predictive value, negative predictive value and efficacy were calculated for palpation (48.7 %, 95.5 %, 79.2 %, 84.1 %, 83.3 % respectively), ultrasonography (65.8 %, 83.0 %, 56.8 %, 87.7 %, 78.7 % respectively), ultrasound-guided fine needle aspiration cytology (86.7 %, 87.5 %, 81.3 %, 91.3 %, 87.2 % respectively) and computed tomography (52.5 %, 83.6 %, 53.9 %, 82.9 %, 75.3 % respectively). Conclusions. In the assessment of lymph node metastases of the neck in patients with primary head and neck cancer, we found a high specificity for palpation of the neck and an acceptable efficacy for both ultrasonography and computed tomography being comparable between the two methods. Efficacy of ultrasound-guided fine needle aspiration cytology was high approaching the value of 90 %.

Insights Into Levator Muscle Dysfunction in a Cohort of Patients With Molecularly Confirmed Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome Using High-Resolution Imaging, Anatomic Examination, and Histopathologic Examination

OBJECTIVE To study the basis of defective levator palpebrae superioris (LPS) function in blepharophimosis-ptosis-epicanthus inversus syndrome (BPES), an autosomal dominant eyelid malformation sometimes associated with ovarian dysfunction. METHODS Eight patients with molecularly proved BPES underwent high-resolution surface-coil 3-T magnetic resonance imaging before surgical intervention. The features of LPS muscle and adjoining connective tissue were compared with an age-matched control subject. During LPS resection for ptosis repair, detailed anatomic examination of the LPS was performed. Histopathologic characteristics were compared with normal control samples from a cadaver and a patient with simple severe congenital ptosis. RESULTS The most striking feature shown on magnetic resonance imaging was the thin, long anterior part of the LPS. During the operation, this consisted of a disorganized, thin, long aponeurosis. However, in the posterior part of the LPS, there was an organized thick structure suggestive of a muscle belly. Histopathologic examination revealed posteriorly well-formed striated muscle fibers in all patients with BPES but not in the control sample from the patient with simple severe congenital ptosis. These striated muscle fibers were comparable to those of the normal control tissue but were more intermixed with collagenous tissue and little fatty degeneration. CONCLUSIONS The presence of striated muscle fibers in LPS of patients with BPES contrasts with the fatty degeneration in patients with simple severe congenital ptosis. To our knowledge, this is the first study providing novel insights into the pathogenesis of the eyelid malformation in BPES through extensive imaging, anatomic study, and histopathologic testing in a unique cohort of patients with molecularly proved BPES.

F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)-positive parotid incidentaloma: Prevalence and clinical significance

Correspondence: Ingeborg Goethals Department of Nuclear Medicine, Polikliniek 7, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium Tel +32 9 332 30 28 Fax +32 9 332 38 07 Email ingeborg.goethals@ugent.be Aim: To evaluate the prevalence of parotid incidentaloma identifi ed by F-18 fl uorodeoxyglucose PET(-CT) scan and the clinical signifi cance associated with this fi nding. Methods: Records from all patients from January 1, 2005 to August 31, 2007 who had focal intense abnormal F-18 FDG uptake in the parotid glands without a previous history of squamous cell carcinoma in the head and neck, lymph node metastasis from an unknown primary in the head and neck region or lymphoma, were reviewed. Results: Of the 5476 PET-CT scans performed in as many patients, focal high-grade parotid F-18 FDG uptake was observed in 18 patients (prevalence of 0.3%). Eight patients (44%) underwent surgery. Four of 8 patients (50%) had benign tumors, 2 (25%) had infectious disease and 1 patient each had metastatic disease from a melanoma and a non-Hodgkin’s lymphoma. Conclusion: F-18 FDG PET-positive parotid incidentaloma is rare. The prevalence of a PETpositive parotid incidentaloma in our study was 0.3%. Clear-cut focal high-grade abnormal F-18 FDG uptake was seen in benign tumors, infectious and metastatic disease.

Speech characteristics in a Ugandan child with a rare paramedian craniofacial cleft: A case report

The purpose of this study is to describe the speech characteristics in an English-speaking Ugandan boy of 4.5 years who has a rare paramedian craniofacial cleft (unilateral lip, alveolar, palatal, nasal and maxillary cleft, and associated hypertelorism). Closure of the lip together with the closure of the hard and soft palate (one-stage palatal closure) was performed at the age of 5 months. Objective as well as subjective speech assessment techniques were used. The speech samples were perceptually judged for articulation, intelligibility and nasality. The Nasometer was used for the objective measurement of the nasalance values. The most striking communication problems in this child with the rare craniofacial cleft are an incomplete phonetic inventory, a severely impaired speech intelligibility with the presence of very severe hypernasality, mild nasal emission, phonetic disorders (omission of several consonants, decreased intraoral pressure in explosives, insufficient frication of fricatives and the use of a middorsum palatal stop) and phonological disorders (deletion of initial and final consonants and consonant clusters). The increased objective nasalance values are in agreement with the presence of the audible nasality disorders. The results revealed that several phonetic and phonological articulation disorders together with a decreased speech intelligibility and resonance disorders are present in the child with a rare craniofacial cleft. To what extent a secondary surgery for velopharyngeal insufficiency, combined with speech therapy, will improve speech intelligibility, articulation and resonance characteristics is a subject for further research. The results of such analyses may ultimately serve as a starting point for specific surgical and logopedic treatment that addresses the specific needs of children with rare facial clefts.

Late mucosal ulcers in dose-escalated adaptive dose-painting treatments for head-and-neck cancer

Abstract Background: To identify predictive factors for the development of late grade 4 mucosal ulcers in adaptive dose-escalated treatments for head-and-neck cancer. Material and methods: Patient data of four dose-escalated three-phase adaptive dose-painting by numbers (DPBN) clinical trials were analyzed in this study. Correlations between the development of late grade 4 ulcers and factors related with the treatment, disease characteristics and the patient were investigated. Dosimetrical thresholds were searched among the highest doses received by 1.75 cm3 (D1.75cc) of the primary gross tumor volume (GTVT) and the corresponding normalized isoeffective dose (NID21.75cc, with a reference dose of 2Gy/fraction and α/β of 3 Gy). Results: From 39 studied patients, nine developed late grade 4 mucosal ulcers. The continuation to either smoke or drink alcohol after therapy was the factor that showed a strong (eight out of nine patients) association with the occurrence of grade 4 ulcers. Six of the patients who continued to smoke or/and drink had D1.75cc and NID21.75cc above 84 Gy and 95.5 Gy, respectively. Seven of the patients with grade 4 had the dose levels above these thresholds, but even if the D1.75cc threshold was significant in the prediction of late grade 4 ulcers, it could not be considered as the only contributing factor. Conclusions: The search for patterns provided strong reasons to apply a dosimetrical threshold for the peak-dose volume of 1.75 cm3 as a preventive measure for late grade 4 mucosal ulcers. Also, patients that continue to smoke or drink alcohol after therapy have increased risk to develop late mucosal ulcers.