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Biomedical subjects

V J Lund

Publications and source records attributed to V J Lund.

At least 55 records · Page 3Linked to original sources
PubMed1998

Craniofacial resection for tumors of the nasal cavity and paranasal sinuses--a 17-year experience.

BACKGROUND: The rarity of sinonasal tumors has precluded long-term follow-up of large series of craniofacial resections until now. METHODS: A series of 209 patients suffering from a wide range of histologies who had undergone craniofacial resection for sinonasal neoplasia with up to 17 years' follow-up were analyzed. RESULTS: An overall actuarial survival of 51% at 5 years and 41% at 10 years was found for the cohort as a whole. For malignant tumors, the 5-year actuarial survival was 44%, falling to 32% at 10 years. For benign pathology, the actuarial survival was 75% at both 5 and 10 years. Statistical analysis identified three factors which significantly affect outcome and survival: malignant histology, brain involvement, and orbital involvement. Few complications are associated with the surgery, with the mean post-operative stay being 16 days. CONCLUSIONS: The improved survival and minimal morbidity and mortality associated with craniofacial resection make it the optimum approach to sinonasal tumors.

Actuarial Analysis↗
PubMed1998

Endoscopic management of paranasal sinus mucocoeles.

Mucocoeles of the paranasal sinuses are relatively uncommon and in the past have been generally treated by an external surgical approach. Forty-eight mucocoeles in the frontal, fronto-ethmoidal and sphenoidal sinuses have been treated during the last five years, 20 by an entirely endonasal endoscopic approach and 28 by a combination of an external procedure and an endoscopic approach. There were no recurrences in the endoscopic group, with a mean follow-up of 34 months whilst three recurrences occurred in the combined external and endoscopic group which had a mean follow-up of 44 months. This may reflect the complexity and severity of concomitant disease. If a wide marsupialization can be achieved by an entirely endoscopic approach there are a number of advantages, notably a lack of facial scarring in children and young adults.

Adolescent↗
PubMed1998

Assessment by nasal biopsy of long-term use of mometasone furoate aqueous nasal spray (Nasonex) in the treatment of perennial rhinitis.

Allergic rhinitis is associated with specific histopathologic changes in the nasal mucosa including squamous metaplasia and local eosinophilia. Previous studies have shown that mometasone furoate aqueous nasal spray is effective and well tolerated in reducing perennial rhinitis and seasonal allergic rhinitis symptoms. We undertook a multicenter, open-label study to evaluate, by nasal biopsy, the tissue changes associated with mometasone furoate use (200 microg/day) during a 12-month treatment period in patients with perennial rhinitis. Of the 69 patients enrolled in the study, 52 completed all 12 months of treatment. Nasal biopsy specimens obtained from patients at baseline and after treatment were evaluated in a blinded fashion by computerized image analysis, qualitative histologic examination, and immunocytochemistry. Morphologic examination of nasal biopsy specimens showed a decrease in focal metaplasia, no change in epithelial thickness, and no sign of atrophy after treatment with mometasone furoate. Immunocytochemical analyses of nasal biopsy specimens obtained before and after treatment revealed a significant decrease in major basic protein-positive eosinophils and tryptase-positive mast cells in the epithelium and lamina propria after treatment. Mometasone furoate appeared to attenuate the inflammatory process by reducing the extent of inflammatory cell infiltration, particularly of eosinophils. This study demonstrated that long-term administration of mometasone furoate is not associated with adverse tissue changes in the nasal mucosa of patients with perennial rhinitis.

Administration, Intranasal↗
PubMed1997

Staging for rhinosinusitis.

Interest in the surgical treatment of chronic rhinosinusitis has increased, primarily because rigid endoscopy and, more particularly, computed tomographic scanning have facilitated the visualization of disease. At the same time it has become both scientifically and financially imperative to audit therapeutic outcome. Consequently, a staging system for nonneoplastic sinus disease is needed. It is clear that any assessment of medical or surgical therapeutic response requires a method of quantifying disease severity that will be widely accepted by practitioners in the field. This acceptance will largely depend on how easy the method is to apply. With computed tomographic scanning it is possible to more accurately determine the extent of the pathologic condition in rhinosinusitis, a disease in which the severity of symptoms and the appearances on nasal endoscopy have a significantly more unpredictable correlation with the extent of disease. One goal of the Task Force on Rhinosinusitis of the American Academy of Otolaryngology-Head and Neck Surgery was to recommend a system for outcomes research that combines quantification with ease of application.

Acute Disease↗
PubMed1997

Closure of the nasal cavities in the treatment of refractory hereditary haemorrhagic telangiectasia.

From a cohort of 35 patients with hereditary haemorrhagic telangiectasia (HHT), 12 patients have undergone closure of the one or both nasal cavities during the last three years for refractory epistaxis. All had failed other forms of treatment including hormone therapy, laser coagulation and septodermoplasty. All patients were available for follow-up at six months or longer. In all patients where complete closure was achieved (11 out of 12) bleeding ceased completely from the operated side.

Adult↗
PubMed1997

A retrospective study of the role of the argon laser in the management of epistaxis secondary to hereditary haemorrhagic telangiectasia.

Epistaxis is a common symptom in patients with hereditary haemorrhagic telangiectasia. It may vary in severity from infrequent mild bleeds to regular severe bleeding, the latter requiring multiple blood transfusions. Laser, which can be used to coagulate the telangiectasia without destroying the overlying nasal mucosa, would theoretically seem to be the ideal mode of treatment. In this pilot study, an argon laser has been used on nineteen patients with hereditary haemorrhagic telangiectasia and is shown to be beneficial in patients with mild or moderate epistaxis. Patients with severe epistaxis, or who fail argon laser treatment, are candidates for alternative therapeutic strategies such as a modified Young's procedure.

Adolescent↗
PubMed1997

Orbital decompression for thyroid eye disease: a comparison of external and endoscopic techniques.

The results of orbital decompression for thyroid eye disease are presented in a cohort of 33 patients. It was performed by an external Patterson approach in 21 individuals and in 13 by an endonasal endoscopic approach. The endoscopic approach was entirely comparable in respect of improvement in axial proptosis, giving a mean improvement of 4.4 mm as compared with a mean of 3.8 mm for the external approach, and produced a demonstrable improvement in visual acuity and perception of colour in three individuals, where this was compromised, and was associated with fewer complications.

Adult↗
PubMed1996

The treatment of hyposmia with intranasal steroids.

Hyposmia is a neglected symptom in patients with rhinitis. We studied 25 patients presenting with perennial rhinitis. Fifteen patients expressed hyposmia as a significant symptom. University of Pennsylvania smell identification test (UPSIT) and visual analogue scales (VAS) were used to score the symptoms of hyposmia, nasal obstruction and nasal discharge before and after six weeks treatment with betamethasone sodium phosphate drops. Those patients with initial symptoms of hyposmia significantly improved their UPSIT scores (p = 0.00009) and their VAS scores for hyposmia (p = 0.00133). Despite a significant decrease in the sensation of nasal obstruction, the non-hyposmics showed no increase in UPSIT scores after betamethasone therapy. There was no clear correlation between UPSIT results and other symptom scores. The judicious use of betamethasone drops in the treatment of rhinogenic hyposmia can be recommended.

Adolescent↗
PubMed1996

Unilateral choanal atresia in siblings--a rare occurrence.

The genetic aspects of choanal atresia have not been clearly defined though it is probably a multifactorial trait as in cleft lip and cleft palate. The appearance of the condition in both single and successive generations supports this contention. Choanal atresia can occur as an isolated anomaly, but is more commonly associated with one or more concomitant congenital anomalies. In this report two sisters both in their teens presented with unilateral choanal atresia as an isolated anomaly. Endoscopic trans-nasal repair of choanal atresia was performed in both of them as this offers excellent visualisation and access.

Adolescent↗
PubMed1996

Enhanced magnetic resonance imaging and subtraction techniques in postoperative evaluation of craniofacial resection for sinonasal malignancy.

The use of magnetic resonance imaging (MRI) enhanced with gadolinium. and diethylenetriamine pentaacetic acid (DTPA) in the preoperative evaluation of sinonasal malignancy is well established and has an accuracy of over 98%. Since 1979, 208 patients have undergone craniofacial resection at London's Institute of Laryngology & Otology, primarily for sinonasal neoplasia affecting the anterior skull base. Thirty-five "high-risk" patients had MRI at follow-up. The MRI scans were assessed before the patients were examined under anesthesia. MRI was assessed before examination under anesthesia and the results compared with histologic findings demonstrating a reasonable degree of positive correlation but one which is inferior to that found preoperatively (80%). An extension of this technique using the subtraction of T1-weighted MRI with Gd-DTPA highlights areas of increased vascularity, which significantly improves the ability to predict recurrence at the skull base and above the surgical repair in the anterior cranial fossa (94%).

Adult↗
PubMed1996

Seasonal allergic rhinitis--a review of current therapy.

Epidemiological studies in many countries strongly suggest an increase in the prevalence of seasonal allergic rhinitis, particularly in urban communities. The mechanisms of allergic rhinitis have been the subject of much research, elucidating symptomatology and improving the focus of therapeutic strategies. Ideally, avoidance of the offending allergen may be undertaken but is often incompatible with normal activity. Thus, active therapy is usually required, selected from a range of pharmacologic agents. Choice is determined by the severity of the symptoms, the age and individual circumstances of the patients, and may vary considerably from country to country. The menu will primarily include rapid onset, oral non-sedating H1 antihistamines, topical nasal steroids and topical sodium cromoglycate to the nose, eyes or both. These medications may be given alone or in combination, usually under the direction of the primary care physician, and should be commenced in advance of exposure to the seasonal allergen. If this proves ineffective, specialist referral should be made for further management.

Adrenal Cortex Hormones↗
PubMed1995

The treatment of chronic sinusitis: a controversial issue.

The persistence of sinusitis after upper respiratory tract infection is influenced by a range of aetiological factors such as anatomical variation which may be surgically corrected, mucociliary abnormalities and immune deficiency. The latter is more common than previously realised, encompassing IgG subclass deficiency, reduced opsonization and Fc gamma receptor polymorphism. This has therapeutic implications, with the possibility of IgG replacement therapy and vaccination. CT scanning suggests that the age of the patient and anatomical abnormalities are important aetiological factors in chronic rhinosinusitis. Only when medical therapy fails, is surgery considered. Although a range of surgical procedures are available, an endoscopic approach may be directed at the ostiomeatal complex and is generally very conservative. Scanning is a prerequisite to this surgery, demonstrating both the extent of disease and the anatomy but requires careful interpretation. Furthermore, an endoscopic technique can be employed for a number of other sinus conditions though this should only be undertaken by an experienced surgeon. A long-term prospective study of children undergoing radical sinus surgery for neoplasia strongly suggests that concerns that surgery in the middle meatus might disturb subsequent facial development are unfounded.

Adolescent↗
PubMed1995

The effect of long-term antibiotic therapy upon ciliary beat frequency in chronic rhinosinusitis.

The mucociliary escalator is the first line of defence of the upper and lower respiratory tracts (Greenstone and Cole, 1985; Sleigh et al., 1988). Failure of mucociliary clearance is associated with chronic or recurrent respiratory tract infection. Ten patients with chronic rhinosinusitis underwent nasal brushings for the assessment of ciliary beat frequency. In two no beating cilia were seen; in the remainder the mean value was 9.3 Hz +/- 2.3; range 6.1-12.8 Hz (n = 8). Following three months continuous oral antibiotic therapy repeat nasal brushings demonstrated increased ciliary beat frequencies in all patients, mean value 13.7 Hz +/- 1.6; range 11.5-16.3 Hz (n = 10); (p < 0.01; paired t-test). Depression of mucociliary clearance can occur secondarily to chronic infection and is improved by prolonged antibiotics.

Adolescent↗
PubMed1995

Monitoring fluctuations in nasal patency in children: acoustic rhinometry versus rhinohygrometry.

Simple rhinohygrometry and passive rhinomanometry studies have suggested that the 'nasal cycle' in children is often different in pattern of that of adults and experimental animals. We aimed to establish whether this assertion was correct, using a reliable and sensitive method, acoustic rhinometry (AR), and to compare results with those of simple rhinohygrometry (RH). Healthy children with no evidence of nasal disease were examined (n = 15; age range three to 10 years; mean age six years). Simultaneous recordings using AR and RH were made on each child every 10-15 minutes over two to four hour periods. Six children underwent nine additional AR studies on separate occasions. 'Classical' reciprocal alternating patterns were evident in 80 per cent (12/15) AR and 53 per cent (8/15) RH studies, 'in concert' patterns in seven per cent (1/15) AR and 20 per cent (3/15) RH studies and 'irregular' patterns in 13 per cent (2/15) AR and 27 per cent (4/15) RH studies. The agreement between the two methods was 47 per cent, with a kappa (kappa) value of -0.17 (poor agreement compared to chance). Agreements between the acoustic rhinometry parameters were 'fair' for all data (kappa = 0.34) and excellent (kappa = 1.0) if irregular patterns were ignored. Repeated studies showed that the pattern of fluctuation varies within any particular individual. The nasal cycle is similar in pattern in children and adults, and acoustic rhinometry is currently the method of choice to further investigate and clarify this phenomenon.

Child↗
PubMed1995

A placebo-controlled study of fluticasone propionate aqueous nasal spray and beclomethasone dipropionate in perennial rhinitis: efficacy in allergic and non-allergic perennial rhinitis.

BACKGROUND: Fluticasone propionate is a new potent, topically active corticosteroid with negligable oral bioavailability. Data on its comparative efficacy in perennial allergic and non-allergic rhinitis are limited. OBJECTIVE: To compare the efficacy and safety of fluticasone propionate aqueous nasal spray (FPANS) 200 micrograms once or twice daily with beclomethasone dipropionate aqueous nasal spray (BPD) 200 micrograms twice daily and placebo in patients with allergic and non-allergic perennial rhinitis. METHODS: The 12-week study had a multicentre, double-blind, randomized, parallel group design. Efficacy was assessed from symptom scores recorded on daily diary cards. RESULTS: FPANS 200 micrograms once or twice daily was significantly better than placebo but not better than BDP in relieving the nasal symptoms of rhinitis. FPANS at either dose was equally effective in the treatment of allergic and non-allergic perennial rhinitis. There were few adverse events and no treatment-related abnormalities in laboratory measurements in either FPANS-treated group. Comparison between treatment groups indicated that FPANS was as well tolerated as placebo and BDP at the doses studied. CONCLUSIONS: In the majority of patients FPANS 200 micrograms once daily in as effective as BDP 200 micrograms twice daily in the relief of perennial allergic rhinitis.

Administration, Intranasal↗