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Biomedical subjects

Valerie J Lund

Publications and source records attributed to Valerie J Lund.

At least 19 recordsLinked to original sources
PubMed2006

Craniofacial resection for tumors of the nasal cavity and paranasal sinuses: a 25-year experience.

BACKGROUND: Craniofacial resection is the established "gold standard" for surgical treatment of tumors affecting the anterior skull base. METHODS: This study analyzed 308 patients (220 males, 88 females) who had undergone craniofacial resection for sinonasal neoplasia with up to 25-year follow-up. RESULTS: An overall actuarial survival of 65% at 5 years and 47% at 10 years was found for the cohort as a whole. For patients with malignant tumors, the 5-year actuarial survival was 59%, falling to 40% at 10 years. For patients with benign pathology, the actuarial survival was 92% at 5 years falling to 82% at 10 years. Statistical analysis again identified brain involvement, type of malignancy, and orbital involvement as the 3 most significant prognostic factors. CONCLUSION: Analysis of one of the largest single institution cohorts over a 25-year period provides a baseline against which other approaches such as an entirely endoscopic skull base resection must be judged.

Adolescent↗
PubMed2006

Rhinosinusitis: developing guidance for clinical trials.

The Rhinosinusitis Initiative was developed by 5 national societies. The current guidance document is an expansion of the 2004 publication "Rhinosinusitis: Establishing definitions for clinical research and patient care" and provides templates for clinical trials in antimicrobial, anti-inflammatory, and symptom-relieving therapies for the following: (1) acute presumed bacterial rhinosinusitis, (2) chronic rhinosinusitis (CRS) without nasal polyps, (3) CRS with nasal polyps, and (4) classic allergic fungal rhinosinusitis. In addition to the templates for clinical trials and proposed study designs, the Rhinosinusitis Initiative has developed 6 appendices, which address (1) health outcomes, (2) nasal endoscopy and staging of CRS, (3) radiologic imaging, (4) microbiology, (5) laboratory measures, and (6) biostatistical methods.

Chronic Disease↗
PubMed2006

Rhinosinusitis: Developing guidance for clinical trials.

The Rhinosinusitis Initiative was developed by 5 national societies. The current guidance document is an expansion of the 2004 publication, "Rhinosinusitis: Establishing definitions for clinical research and patient care" and provides templates for clinical trials in antimicrobial, anti-inflammatory, and symptom-relieving therapies for the following: (1) acute presumed bacterial rhinosinusitis, (2) chronic rhinosinusitis (CRS) without nasal polyps, (3) CRS with nasal polyps, and (4) classic allergic fungal rhinosinusitis. In addition to the templates for clinical trials and proposed study designs, the Rhinosinusitis Initiative has developed 6 appendices, which address (1) health outcomes, (2) nasal endoscopy and staging of CRS, (3) radiologic imaging, (4) microbiology, (5) laboratory measures, and (6) biostatistical methods.

Chronic Disease↗
PubMed2006

Complications of surgery for nasal polyposis and chronic rhinosinusitis: the results of a national audit in England and Wales.

OBJECTIVE: The objective of this study was to determine the rate of complications of surgery for nasal polyposis and chronic rhinosinusitis as well as their risk factors. STUDY DESIGN, SETTING, PARTICIPANTS, AND OUTCOME MEASURES: The authors conducted a prospective study of 3,128 patients who underwent sinonasal surgery during 2000 and 2001 in 87 National Health Service hospitals in England and Wales. Patients completed a preoperative questionnaire that included the Sino-Nasal Outcome Test, a measure of sinonasal symptoms severity and health-related quality of life. Surgeons provided information about polyp extent, opacity of the sinuses on computed tomography (Lund-Mackay score), comorbidity (American Society of Anesthesiologists score), and the occurrence of perioperative complications. RESULTS: Major complications (orbital or intracranial complications, bleeding requiring ligation or orbital decompression, or return to the operating room) occurred in 11 patients (0.4%). Minor complications (all other untoward events) occurred in 207 patients (6.6%). Most frequently reported minor complications were excessive perioperative hemorrhage bleeding (5.0%) as well as postoperative hemorrhage requiring treatment (0.8%). Multivariate analysis indicated that the complication rate was linked to the extent of disease measured in terms of symptom severity and health-related quality of life, the extent of polyposis, level of opacity of the sinuses on computed tomography, and the presence of comorbidity, but not surgical characteristics (extent of surgery, use of endoscope or microdebrider, grade of surgeon, and adjunctive turbinate surgery). CONCLUSIONS: The risk of complications depended on patient characteristics rather than on the surgical technique used. Measures of the extent of disease and comorbidity may help in identifying patients at high risk of complications.

Adolescent↗
PubMed2006

Yearly incidence of rhinitis, nasal bleeding, and other nasal symptoms in mature women.

OBJECTIVES/HYPOTHESIS: To evaluate, by a prospective questionnaire study, the incidence of spontaneous nasal pathology in mature women over a 12-month period, in particular nasal bleeding and the relationships of these symptoms with various factors. METHODS: Participants were drawn from a sample of 12,735 adult French volunteers participating in a study of antioxidant nutrients ("SU.VI.MAX"); 3500 women aged 50-64 years were randomly selected from good responders in the SU.Vl.MAX population. The responses of 2197 women were analysed. RESULTS: Nearly 70% of subjects reported at least one episode of rhinitis, with a mean (SD) of 1.88 (2.17) episodes per subject. Rhinitis was related to passive exposure to tobacco smoke (adjusted odds ratio [OR] 1.31, 95% CI 1.05-1.63), menopause (OR 1.47, 95% CI 1.16-1.88), and occupational exposure to vapours or dusts (OR 1.55, 95% CI 1.01-2.37). Nasal bleeding was reported as traces of blood by 16.5% of subjects, and as epistaxis (significant nasal bleeding) by 7.6%. Both symptoms were related to passive exposure to tobacco smoke (OR 1.63, 95% CI 1.22-2.19; OR 1.56, 95% CI 1.05-2.32, respectively) but not to use of systemic or topical medication. CONCLUSION: A substantial number of mature women experience nasal symptoms during the course of a year. Rhinitis and nasal bleeding were correlated with passive exposure to tobacco smoke.

Dust↗
PubMed2006

Peak nasal inspiratory flow; normal range in adult population.

AIMS: Measurement of Peak Nasal Inspiratory Flow (PNIF) seems to be a cheap, simple, easily performed method to assess nasal patency. The purpose of this study is to establish normative PNIF data for a healthy adult population and provide charts relating PNIF normal values with age, height and sex in adults. METHODS AND RESULTS: Repeated measurements of PNIF were performed in 170 volunteers. In total, 137 of these fulfilled the study criteria (66 females and 50 males) and all of them were non-smokers, non-asthmatic, without nose and paranasal sinuses problems, with ages ranging from 16 to 84 years. Data were statistically analysed and tables were produced relating PNIF to age, sex and height. There was no interaction of sex with age or height. There was considerable residual variability of PNIF between individuals not explained by any of the variables studied. CONCLUSIONS: We conclude that PNIF could be a useful method to study nasal patency in both primary and secondary care to aid diagnosis of nasal disease. The study provides normative data for a Caucasian population. Further variables need to be explored to predict expected PNIF values more accurately.

Adolescent↗
PubMed2005

Maximal medical therapy for chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is widely recognized as one of the most common, if not the most common, chronic disease entities. This article discusses CRS without nasal polyposis. The discussion of maximal medical therapy concentrates on the best available evidence from published clinical trials.

Adrenal Cortex Hormones↗
PubMed2005

Nasal fibrosis: long-term follow up of four cases of eosinophilic angiocentric fibrosis.

Eosinophilic angiocentric fibrosis is a rare, benign cause of submucosal thickening and fibrosis within the upper respiratory tract. It predominantly affects the nose although cases have been reported in the subglottis. We describe four cases of the disease centred around the nasal cavity, with widespread infiltration of the facial soft tissues and orbit in three of the four patients. Each underwent long term follow up. Multiple surgical resections were required with two of our patients and, to date, medical therapy has been of limited help. The disease process, with its clinical and characteristic histopathological findings, is described. We also discuss the management of the disease following a comprehensive review of, and comparison with, the few prior reported cases.

Aged↗
PubMed2005

Ethnic variation in sinonasal anatomy on CT-scanning.

Computed tomography (CT) scanning of the paranasal sinuses provides valuable information in assessing extent of disease and fine detailed anatomy prior to endoscopic sinus surgery. Awareness of the different anatomic variants of the bony sinonasal anatomy will help the rhinologic surgeon's orientation during the procedure. We conducted a study to look at the incidence of the anatomic variation within the lateral wall of the nose and sinuses and to determine if there is any ethnic difference in these variants between a cohort of 100 Caucasian patients undergoing endoscopic sinus surgery in London and 100 Chinese patients treated in Hong Kong. We compared the two groups with chi-square test and the significant areas are those with p value of less than 0.05. The results show a higher incidence of pneumatisation of the middle turbinate (concha bullosa) and paradoxical bending of the middle turbinate in the Caucasian population. The infraorbital and suprabullar cell development was greater in the Caucasian population though the incidence of sphenoethmoidal cells was much greater in the Chinese population. When asymmetry of the anterior ethmoidal roof was considered, the left was consistently the highest in both groups, though there was no difference in the depth of the cribiform niche between right and left or between Caucasian and Chinese. The incidence of bent uncinate process and of complete absence of a sinus was higher in the Chinese population. There was no difference in the presence of pneumatisation of the agger nasi, of the uncinate process, or of the anterior clinoid process. There was no difference in the presence of septation adjoining the carotid in the lateral wall of sphenoid or in the exposure of the optic nerve within sphenoid or posterior ethmoid sinuses. Although there is no evidence that variants of the sinonasal anatomy seen on CT Scan have a causative effect in the disease process; a knowledge of their presence is paramount in minimising the potential for surgical complications.

Adolescent↗
PubMed2004

Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial.

OBJECTIVES: To conduct the first prospective, randomized, controlled trial evaluating and comparing the medical and surgical treatment of polypoid and nonpolypoid chronic rhinosinusitis (CRS). MATERIALS AND METHODS: Ninety patients with CRS were equally randomized either to medical or surgical therapy. All patients underwent pre- and posttreatment assessments of visual analogue score (VAS), the Sinonasal Outcome Test-20 (SNOT-20), the Short Form 36 Health Survey (SF-36), nitric oxide (NO), acoustic rhinometry, saccharine clearance time (SCT), and nasal endoscopy. Each patient had three assessments: before starting the treatment, after 6 months, and, finally, after 1 year. RESULTS: Both the medical and surgical treatment of CRS significantly improved almost all the subjective and objective parameters of CRS (P <.01), with no significant difference being found between the medical and surgical groups (P >.05), except for the total nasal volume in CRS (P <.01) and CRS without polyposis (P <.01) groups, in which the surgical treatment demonstrated greater changes. CONCLUSION: CRS should be initially targeted with maximal medical therapy (e.g., a 3 month course of a macrolide antibiotic, douche, and topical steroid), with surgical treatment being reserved for cases refractory to medical therapy. The presence of nasal polyps is not a poor prognostic factor for the efficacy of CRS therapy, either surgical or medical.

Adult↗
PubMed2004

Database for the collection and analysis of clinical data and images of neoplasms of the sinonasal tract.

The Neoplasms of the Sinonasal Tract software package (NSNT v 1.0) implements a complete visual database for patients with sinonasal neoplasia, facilitating standardization of data and statistical analysis. The software, which is compatible with the Macintosh and Windows platforms, provides multiuser application with a dedicated server (on Windows NT or 2000 or Macintosh OS 9 or X and a network of clients) together with web access, if required. The system hardware consists of an Apple Power Macintosh G4500 MHz computer with PCI bus, 256 Mb of RAM plus 60 Gb hard disk, or any IBM-compatible computer with a Pentium 2 processor. Image acquisition may be performed with different frame-grabber cards for analog or digital video input of different standards (PAL, SECAM, or NTSC) and levels of quality (VHS, S-VHS, Betacam, Mini DV, DV). The visual database is based on 4th Dimension by 4D Inc, and video compression is made in real-time MPEG format. Six sections have been developed: demographics, symptoms, extent of disease, radiology, treatment, and follow-up. Acquisition of data includes computed tomography and magnetic resonance imaging, histology, and endoscopy images, allowing sequential comparison. Statistical analysis integral to the program provides Kaplan-Meier survival curves. The development of a dedicated, user-friendly database for sinonasal neoplasia facilitates a multicenter network and has obvious clinical and research benefits.

Computers↗
PubMed2004

Etiology of chronic rhinosinusitis: the role of fungus.

Chronic rhinosinusitis is an inflammatory disorder with numerous predisposing factors, including genetics, pollution, anatomic anomalies, bacteria, and fungus. In some studies, fungi have been cultured from nearly 100% of patients with rhinosinusitis and nasal polyposis. T-cell sensitization to fungus with production of the T-helper 2 (Th2) cytokine interleukin-5 has been proposed as a key step in the initiation of the disease. Interleukin-5 also plays an important role in the effector phase of the disease through its effects on eosinophilopoesis and eosinophil survival. There is considerable controversy concerning the role of fungi as the cause of "chronic eosinophilic rhinosinusitis" and whether this even represents a distinct clinical entity. Further study is also required to define the optimal treatment for the disease.

Animals↗
PubMed2004

Efficacy and tolerability of budesonide aqueous nasal spray in chronic rhinosinusitis patients.

This study evaluated the efficacy and tolerability of budesonide in an aqueous nasal spray (BANS) in patients with chronic rhinosinusitis. In this double-blind, placebo-controlled, multicentre, parallel-group study, patients (n = 167) with persistent rhinosinusitis symptoms despite 2-weeks' antibiotic treatment were randomised to receive BANS 128 micrograms b.i.d. or placebo for 20 weeks. Morning combined symptom scores (CSS) in patients receiving BANS decreased by a mean of -1.85 (95% CI -2.27, -1.43), versus -1.02 (-1.43, -0.61) in the placebo group (p = 0.005); corresponding values for evening CSS were -1.78 (-2.22, -1.35) and -1.02 (-1.45, -0.60), respectively (p = 0.012). BANS produced significant reductions in nasal congestion and discharge scores, and improved patients' sense of smell (morning only), versus placebo. Peak nasal inspiratory flow (PNIF) increased significantly during BANS treatment. In allergic patients, BANS significantly (p < 0.001) reduced both morning -1.40 (-2.18, -0.62) and evening -1.37 (-2.15, -0.58) CSS from baseline versus placebo, but changes in non-allergic patients (morning: -0.04 [-0.95, 0.87]; evening: 0.14 [-0.81, 1.09]) were not significant. PNIF was significantly (p < 0.01) increased in both allergic and non-allergic patients from baseline versus placebo. BANS is an effective and well-tolerated treatment for chronic rhinosinusitis.

Administration, Intranasal↗
PubMed2003

Clinical features and treatment of late enophthalmos after orbital decompression: a condition suggesting cause for idiopathic "imploding antrum" (silent sinus) syndrome.

PURPOSE: To review the clinical and radiologic characteristics of a group of patients who experienced late enophthalmos after bone-removing orbital decompression. The surgical management of these patients is presented and a hypothesis proposed to explain the idiopathic "imploding antrum" ("silent sinus") syndrome. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Six patients experienced relative enophthalmos, hypoglobus, and upper eyelid sulcus deformity at between 3 and 6 months after bone-removing orbital decompression for thyroid orbitopathy. Five left orbits and one right orbit were affected. INTERVENTION: All patients underwent middle meatal antrostomy, together with mobilization and elevation of the collapsed orbital contents by firm packing of the affected maxillary antrum through a buccal antrostomy, the pack being removed about 3 weeks after placement. MAIN OUTCOME MEASURES: Symptomatic improvement and reduction in the degree of relative enophthalmos, hypoglobus, and upper eyelid sulcus deformity. RESULTS: Late-onset enophthalmos after orbital decompression was associated with clinical and radiologic features that resemble the idiopathic imploding antrum syndrome. In all patients, the ethmoidal infundibulum was obstructed by prolapsed orbital fat with secondary antral consolidation, and inward bowing of the maxillary walls was present in five of six patients. After antral drainage and packing, there was an improvement in enophthalmos (mean, 2.7 mm; range, 0-4 mm) and all but one globe returned to within 2 mm of exophthalmometry of the contralateral eye. For recurrent enophthalmos in two patients (minor in one patient and marked in the other), later repair of the orbital floor was undertaken through a lower eyelid swinging flap, using porous polythene sheet, with good cosmetic outcome. CONCLUSIONS: Late-onset enophthalmos after bone-removing orbital decompression seems to be the result of obstruction of maxillary antral aeration, with secondary fluid retention and a subatmospheric pressure in the sinus. This iatrogenic condition, associated in most cases with inward collapse of the maxillary walls, provides a guide to a hypothetical mechanism for the idiopathic imploding antrum (silent sinus) syndrome.

Adult↗
PubMed2003

Olfactory neuroblastoma: past, present, and future?

OBJECTIVE: To consider the long-term survival and outcomes in patients with olfactory neuroblastoma undergoing craniofacial resection. STUDY DESIGN: A single-center prospective cohort study. METHODS: All patients with olfactory neuroblastoma treated in a 23-year period with craniofacial resection (with or without radiotherapy) were analyzed; a multivariate analysis was included. RESULTS: Forty-two patients aged 12 to 70 years were assessed, 83% of whom had received no preceding treatment. Craniofacial resection was used in all cases, combined with radiotherapy in 24 patients (57%). Duration of follow-up ranged from 2 to 206 months (mean follow-up period, 57 mo). The disease-free actuarial survival and overall survival were 77% and 61% at 5 years and 53% and 42% at 10 years, respectively. A Cox regression analysis identified intracranial extension and orbital involvement as independent factors affecting outcome. CONCLUSION: Craniofacial resection combined with radiotherapy offers the gold standard of care against which other approaches such as endoscopic resection must be judged.

Adolescent↗