Rhinitis of granulomatous and vasculitic diseases.
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Autoimmune Diseases↗
Biomedical subjects
Isam Alobid
Publications and source records attributed to Isam Alobid.
The impact of atopy, sinus opacification, and nasal patency on quality of life in patients with severe nasal polyposis.
OBJECTIVES: Nasal polyposis has a great impact on the quality of life. The aim of this study was to evaluate the association between quality of life and atopy, sinus opacification, and nasal patency in severe nasal polyposis. METHODS: One hundred nine patients completed the Medical Outcome Study Short Form-36 (SF-36) survey. Symptoms, polyp size, atopy, nasal patency, and sinus opacification were also scored. RESULTS: Patients showed worse scores in all SF-36 domains, except for physical functioning, compared with Spanish population. Atopic patients had worse scores in role physical, body pain, vitality, and mental health than nonatopic patients. Atopic patients showed lower physical component summary (44.7 +/- 1.1) and mental component summary (38.4 +/- 1.0) than nonatopic patients (48.3 +/- 1.6, 40.6 +/- 1.3; P < 0.05), respectively. There were no correlations between quality of life and symptoms, polyp size, CT scan, nasal patency, and atopy. CONCLUSION: Nasal polyposis has a considerable impact on quality of life and atopy worsens this impact. EBM RATING: C-4.
Adult↗
A short course of oral prednisone followed by intranasal budesonide is an effective treatment of severe nasal polyps.
BACKGROUND: Nasal polyposis is an inflammatory disease of unknown etiology. This study aimed to evaluate the effect of a short course of oral prednisone followed by intranasal budesonide on nasal symptoms, polyp size, nasal flow, and computed tomography scan. METHODS: Eighty-four patients with severe nasal polyps were included. After a steroid washout period, patients were randomized into two groups: group A (n = 63) received oral prednisone for 2 weeks and group B (n = 21) did not receive any steroid treatment. Patients from group A received intranasal budesonide for 12 weeks. RESULTS: Atopy was positive in 36.8% of patients. Blood eosinophilia was higher in asthmatic (7.2 +/- 0.7%, P < .05) than in nonasthmatic (3.0 +/- 0.4%) patients. Asthmatic patients showed higher scores on nasal obstruction and loss of smell than nonasthmatics. Oral steroids caused a significant improvement in all nasal symptoms and improved polyp size (2.1 +/- 0.1, P < .05) and nasal flow (560 +/- 35 cm/s, P < .05) compared with nontreated patients (2.8 +/- 0.1 and 270 +/- 34 cm/s, respectively). Intranasal budesonide maintained the improvement on nasal symptoms, polyp size, and nasal flow. Steroid treatment reduced the computed tomography scan score (15.4 +/- 1, P < .05) compared with before treatment (18.2 +/- 0.8). CONCLUSION: A short course of oral steroids improved all nasal symptoms, polyp size, and nasal flow, whereas intranasal steroid maintain this effect.
Administration, Intranasal↗
Severe nasal polyposis and its impact on quality of life. The effect of a short course of oral steroids followed by long-term intranasal steroid treatment.
OBJECTIVES: Nasal polyposis is not a life-threatening disorder but has a great impact on the quality of life. Steroids constitute the first line of treatment of nasal polyps. The aims of this study were to evaluate the quality of life in nasal polyp patients after: (1) a short course of oral steroids; and (2) a long-term treatment with intranasal steroids. METHODS: Patients with severe nasal polyps received either oral prednisone (n = 60) or no steroid treatment (control group, n = 18) for 2 weeks. Patients treated with steroids were also followed-up and evaluated after 12, 24, and 48 additional weeks with intranasal budesonide treatment. RESULTS: Patients with nasal polyps showed worse scores on all SF-36 domains, except for physical functioning, compared to the Spanish general population. After two weeks, patients treated with oral prednisone demonstrated a significant improvement (p < 0.05) in all impaired QoL domains compared to both control group and baseline. The mental component summary (51.0 +/- 1.2, p < 0.05) and physical component summary (51.0 +/- 0.9, p < 0.05) were improved compared to both control group and baseline. The improvement of all SF-36 domains was sustained by intranasal budesonida (p < 0.05) after 12, 24, and 48 weeks. Nasal obstruction, sense of smell, and polyp size also improved after both the oral short course and the intranasal long-term steroids treatment (p < 0.05). CONCLUSION: These results suggest that the treatment with a short-course of oral steroids improves the quality of life of patients with severe nasal polyps and that this effect is maintained by a long-term treatment with intranasal steroids.
Administration, Intranasal↗
Barcelona Smell Test - 24 (BAST-24): validation and smell characteristics in the healthy Spanish population.
OBJECTIVES: Smell tests for clinical use have been developed in different countries, but no single test has gained general acceptance. The objectives of the study were to evaluate the smell outcomes in a Spanish population. METHODS: A prospective study on healthy volunteers (n = 120) without olfactory disturbances was performed. The volunteers were differentiated by gender, age, and smoking habit groups. We used a new olfactory test, the Barcelona Smell Test 24 (BAST-24) that consists of 24 odours scoring smell detection, identification, and forced choice. RESULTS: Volunteers showed the highest scores on smell detection for both 1st (99%) and 5th cranial nerve (98%) odours. Spontaneous smell identification (54.7% and 59.3%) and forced choice (72.2% and 42.6%) scores were lower than those of smell detection, for both 1st and 5th cranial nerves respectively. On smell identification, volunteers scored higher in the left than in the right nostril. Females had better smell identification for both 1st and 5th cranial nerves (62.8%, 66.7%) than males (50.3%, 58.8%). Non-smokers had higher scores (65%) than smokers (59%) on smell identification for the 5th CN. CONCLUSIONS: For smell identification, females, non-smokers, and left nostril had higher scores than males, smokers, and right nostril respectively. BAST-24 is a good and reliable method to test the olfactory function in the clinical practice.
Adolescent↗
The impact of asthma and aspirin sensitivity on quality of life of patients with nasal polyposis.
BACKGROUND: Nasal polyposis is not a life-threatening disease but may have a great impact on patient's quality of life. OBJECTIVE: To investigate the impact of nasal polyps on quality of life compared with the Spanish general population using the SF-36 questionnaire; and to evaluate the impact of asthma and aspirin sensitivity on quality of life in patients with nasal polyposis. METHODS: We included 130 patients with nasal polyposis and evaluated nasal symptom, CT scan, polyp size, and quality of life. RESULTS: In comparison with the Spanish general population, patients with nasal polyposis had worse scores on all SF-36 domains except for physical functioning. Asthmatic patients with nasal polyposis had worse quality of life than nonasthmatic patients on role physical, body pain, and vitality (p < 0.05). The authors found no significant differences on quality of life, nasal symptoms, polyp size, and CT scan scores between patients with aspirin-tolerant and aspirin-sensitive asthma. CONCLUSION: These results suggest that nasal polyposis has a considerable impact on quality of life. Moreover, asthma but not aspirin sensitivity has an additional negative impact on the quality of life of patients with nasal polyposis.
Adult↗
Solitary fibrous tumor of the larynx.
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Aged↗
Inflammatory myofibroblastic tumor in the larynx: clinicopathologic features and histogenesis.
Inflammatory myofibroblastic tumor is extremely rare in the larynx and can mimic a malignant process. We present the case of a 62-year-old male who required tracheotomy due to rapidly progressive stridor. Laryngoscopy showed an exophytic, occlusive tumor located in the right true vocal cord. CT showed an expansive mass measuring 2 x2 x1.3 cm3 and occupying the anterior commissure, with glottic progression to the right true vocal cord. The tumor was completely resected with a CO2 laser via a transoral approach. Histologic examination demonstrated extensive ulceration with the presence of granulation tissue. The specimen was mainly composed of spindle cells arranged in a fasciculated pattern with a myxoid background and focal hyalinization. Immunohistochemical studies revealed positivity of spindle cells to vimentin, muscle-specific actin and smooth muscle actin. The patient showed no evidence of disease 24 months after surgery.
Humans↗
Peripheral primitive neuroectodermal tumor of the cerebellopontine angle.
Peripheral primitive neuroectodermal tumors are highly malignant small cell neoplasms. A 27-year-old female presented with a 6-month history of right-sided facial pain and progressive weakness of the facial muscles. She had non-pulsative tinnitus, progressive right hearing loss and facial palsy. T2-weighted MRI showed a heterogeneous hyperintense lesion invading the right internal auditory canal. Surgical removal was performed. Pathological examination showed sheets of small cells with irregular nuclei. Immunohistochemical studies demonstrated positive immunoreactivity for neuron-specific enolase, synaptophysin, chromogranin, vimentin, S-100 protein and p30-32 MIC-2 gene product. The patient was treated with chemotherapy (etoposide, vincristine, adriamycin, ifosfamide and actinomycin D) and radiotherapy. After 65 months of follow-up, the patient presented with cervical metastasis. Radical cervical dissection was performed and the patient was treated with a second course of chemotherapy. At control MRI after 29 months of follow-up the patient showed no signs of local recurrence or distant metastasis.
Adult↗
Cerebellopontine angle and internal auditory canal metastasis from ductal carcinoma of the breast.
This is the first formal case report of internal auditory canal and cerebellopontine angle metastasis from infiltrative ductal carcinoma of the breast. Only three previous cases have been reported of isolated metastasis in the cerebellopontine angle and internal auditory canal from breast cancer. Currently, no therapeutic guidelines for isolated metastasis from breast cancer in this location exist. We report a case and review the current literature in order to help characterize the clinicopathologic features and management. A 72-year-old female with a 5-year history of left infiltrative ductal carcinoma of the breast reported progressive left-sided facial palsy and ipsilateral hearing loss accompanied by the development of tinnitus and unsteadiness during the previous 3 months. MRI identified a lesion in the cerebellopontine angle and internal auditory canal. The lesion was completely excised via a retrosigmoidal approach and adjuvant radiotherapy was used subsequently. The patient remains well 18 months after treatment, with no evidence of recurrence on repeat MRI. The rapid evolution of symptoms involving the Vth, VIIth or VIIIth cranial nerve, or multiple cranial nerves, is suggestive of a malignant lesion of the cerebellopontine angle and/or internal auditory canal. A previous history of neoplasm is important due to the possibility of a metastasis. Cerebellopontine angle metastasis can be found many years after the initial diagnosis of breast neoplasm. Surgery and adjuvant radiotherapy seems to be a good choice for the treatment of patients with this specific type of metastasis.
Aged↗
Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis.
INTRODUCTION: Endoscopic surgery of the anterior skull base has become the standard procedure for the repair of cerebrospinal fluid (CSF) leaks of various origins. Closure of the leaks is believed to prevent ascending meningitis, although no report has specifically shown this. MATERIAL AND METHODS: Retrospective chart study of 39 patients who underwent endoscopic skull base surgery from 1/1993 to 11/2002. SETTING: Tertiary University Hospitals. OUTCOME MEASUREMENT: Incidence of ascending meningitis after endoscopic skull base repair in patients with anterior skull base defects associated or not with meningitis and CSF leak. RESULTS: Forty-one endoscopic repairs of anterior skull base defects of various origins were performed in 39 patients. Fifteen (36.5%) had suffered bacterial meningitis before surgery. Mean follow-up was 65 months (range 22-120). The defect was repaired using an "underlay" technique with lyophilized dura (n=11) or fascia lata (n=30), and covered with free mucosal grafts from either the middle or the inferior turbinates. Closure was achieved in 40/41 cases at first attempt. No recurrence of ascending bacterial meningitis was observed during follow-up in any of the fifteen patients who had previously presented with a CSF leak or skull base defect with meningitis. Also, no new bacterial meningitis occurred in all other patients. One case of meningoencephalocele of the lateral sphenoid wall developed a recurrent CSF fistula associated with bacterial meningitis two years after endoscopic repair, requiring endoscopic revision surgery. No patient received vaccination in this series. DISCUSSION: Closure of active CSF leaks and reconstruction of skull base defects without CSF-leak in patients with prior ascending bacterial meningitis seem to provide excellent long-term results with neither recurrence of ascending meningitis nor incidence of meningitis in the other patients, unless a CSF leak re-appears. Conservative treatment of CSF leaks may lead to bacterial meningitis, therefore surgical closure of leaks or defects at the skull base should be considered treatment of choice to prevent ascending meningitis.
Adult↗
Laryngeal solitary fibrous tumor treated with CO2 laser excision: case report.
The solitary fibrous tumor is an uncommon unilateral benign lesion that usually arises from the pleura. Recently, these tumors have been described in many other locations, such as the mediastinum, head and neck, orbit and urogenital system. To date, only two cases of solitary fibrous tumor arising from the larynx have been reported in the scientific literature. We describe a new case of laryngeal solitary fibrous tumor localized at the right false vocal fold. A 29-year-old man presented with a 6-month history of progressive hoarseness and foreign body sensation in the throat. A mass lesion was recognized in the right false vocal fold, and CT scan demonstrated a large, well-defined tumor without signs of infiltration. The tumor was removed by transoral CO(2) laser surgery. The definitive diagnosis was obtained by immunohistochemical analysis that showed vimentin and CD34-positive cells. The patient remains free of tumor after 15 months of follow-up.
Adult↗
Nasal manifestations of systemic illnesses.
This article is focused on the nasal and sinusal manifestations of systemic diseases, such as infections, immunodeficiencies, chronic multisystemic disorders, inflammatory bowel diseases, deposition diseases, hematologic diseases, respiratory diseases, and smell and taste disorders. A concise review of some of the systemic diseases that commonly present complaints in the nose and paranasal sinuses, including their prevalence, sinonasal manifestations, diagnosis, and treatment, is provided.
Acquired Immunodeficiency Syndrome↗
Dynamics of COX-2 in nasal mucosa and nasal polyps from aspirin-tolerant and aspirin-intolerant patients with asthma.
BACKGROUND: Only dynamic studies can elucidate the discrepancies concerning the expression of the inducible COX-2 gene in inflammatory airway diseases. OBJECTIVES: To quantify the expression and spontaneous regulation of COX-1 and COX-2 mRNAs in nasal polyps and nasal mucosa by real-time PCR. METHODS: Nasal polyps were obtained from 16 aspirin-tolerant patients with asthma/rhinitis (ATAR) and 18 aspirin-intolerant patients with asthma/rhinitis (AIAR) undergoing nasal polypectomy. Nasal mucosa was obtained from 12 subjects undergoing nasal corrective surgery. All specimens were cut into 3 pieces. One was immediately snap-frozen in liquid nitrogen, and the remaining 2 were left at room temperature for 30 or 60 minutes before freezing. Data are presented as medians and 25th to 75th percentiles of 10 6 cDNA molecules/microg total RNA. RESULTS: Baseline COX-2 mRNA levels were significantly lower in both ATAR (0.45; 0.13-1.20; P <.05) and AIAR (0.24; 0.12-0.41; P <.001) nasal polyps than in nasal mucosa (1.35; 0.52-3.90). COX-2 mRNA expression did not change over time in nasal mucosa but increased significantly in ATAR nasal polyps ( P <.05), reaching similar levels to nasal mucosa after 60 minutes. In contrast, COX-2 mRNA showed no significant change over time in AIAR nasal polyps. COX-1 mRNA was higher in nasal polyps than in nasal mucosa, and its expression was not modified over time in any group of patients. CONCLUSION: These results suggest differential kinetics of COX-2 mRNA between nasal mucosa and nasal polyps. AIAR nasal polyps appear to have a greater abnormality of the COX-2 pathway than ATAR.
Adult↗
Parapharyngeal angiolipoma causing obstructive sleep apnoea syndrome.
Obstructive sleep apnoea syndrome (OSAS) is the cessation of airflow with the continuance of respiratory effort during sleep. OSAS associated with a neck mass is extremely rare. Angiolipoma is a rare, benign, fatty tumour composed of mature lipocytes and multiple areas containing angiomatous elements. The treatment for an angiolipoma is surgical excision. We report the case of a 47-year-old male who presented with a history of loud snoring associated with sleep apnoea. A polysomnographic study demonstrated an apnoea-hypopnoea index of 72/h. CT showed a 3.5 x 3 x 8 cm3 hypoattenuated mass of fat density in the left parapharyngeal space causing an impression on the nasopharynx and oropharynx with a peripheral hyperintense area. A cervical transparotid surgical approach was used. A histological study led to the definitive diagnosis of angiolipomal without evidence of malignancy. After surgery, the snoring disappeared and the patient remained tumour-free after 54 months of follow-up. This is the first case in the literature of a patient with nocturnal polysomnographic-documented OSAS caused by a left parapharyngeal angiolipoma.
Angiolipoma↗
Transoral approach to drain streptococcus pneumoniae spinal epidural abscess in an HIV-infected adult.
Spinal epidural abscess due to Streptococcus pneumoniae is extremely rare in adults. It typically occurs in the thoracic, lumbar or lumbosacral epidural spaces, and less frequently in the cervical epidural space. The principal causative microbial agent is Staphylococcus aureus, representing 70% of cases, while 1.6% of cases are caused by S. pneumoniae. We report the first case of an HIV-infected patient with a cervical spinal epidural abscess. The patient was a 43-year-old male with pneumococcal bacteremia and a metatarsal abscess. He reported cervical pain with muscle spasm during cephalic flexion and extension, fever and a painful tumefaction on the second metatarsal of the left foot. MRI confirmed that the retropharyngeal abscess extended to the cervical spinal epidural space. Antibiotic therapy with cefotaxime plus vancomycin was initiated and a transoral surgical approach was used to achieve retropharyngeal and local debridement of the metatarsal abscess. Blood and pus cultures were positive for S. pneumoniae. After 4 months of follow-up the patient remained asymptomatic, without clinical or MRI evidence of recurrence.
Adult↗
Orbitoethmoid aneurysmal bone cyst. Case report and literature review.
Aneurysmal bone cyst is a benign, vascular, variable growing and expansive lesion that can occur in any part of the skeletal system, but mainly in long bones and vertebrae. We present a case of orbitoethmoid aneurysmal bone cyst in a 62-year-old female presenting epiphora. Nasal endoscopy was normal. Sinus CTscan revealed an expansive mass in the right ethmoid sinus extending and destroying the right lamina papiracea. The tumor was completely resected through paralateral rhinotomy. Histological analysis showed fibrous septa containing multinucleated giant cells and bone tissue surrounding blood vessel lumens, bordered by endothelial cells. These findings are characteristic of aneurysmal bone cysts. After 30 months of postoperative follow-up the patient remains disease-free and asymptomatic.
Bone Cysts, Aneurysmal↗
The antrochoanal polyp.
Antrochoanal polyps (ACP) are benign lesions that arise from the mucosa of the maxillary sinus, grow into the maxillary sinus and reach the choana, and nasal obstruction being their main symptom. It is an interesting model to compare the pathophysiological mechanisms with those of bilateral nasal polyposis (NP). There is a lack of research in some areas of ACP, which have to become the main aims for future investigations of this disease. In comparison to NP, ACPs are usually unilateral and appear in younger patients. Macroscopically, they have a cystic intramaxillary portion and a solid intranasal portion. Microscopically, they are similar to a maxillary cyst of the mucosa. Nasal endoscopy, computed tomography and magnetic resonance are the main diagnostic techniques. Surgery is the indicated treatment for ACP, with endoscopic resection the most recommended. Simple avulsion of the polyp has a high rate of recurrence, whereas the Caldwell-Luc procedure is associated with damage of the maxillary and dental growth centres. More research is needed to establish the relationship between chronic sinusitis and ACP. Further work is also needed to investigate the role of inflammatory mediators (histamine, IgE, adhesion molecules, PAF), as well as metalloproteases and nasal remodelling, and tumour marker expression in A CP.
Humans↗