Article Commentary: Fas and Cancer

Apoptosis is an active process of programmed cell death. Fas is a cell-surface protein which is expressed on activated lymphocytes and known as CD95, TNFRSF6 or APO-1. Fas-L is ligand of Fas and known as CD95 LG or TNFSF6. Apoptosis or cell death is a result of binding of Fas-L to Fas which is expressed on the surfaces of these cells. Cancer cells escape this binding by overexpression of Fas-L or down expression of Fas. Fas and Fas-L exist in membrane bound and soluble forms. The serum level of sFas and sFas-L can be evaluated by immunostaining, immunohistochemical methods, immunofluorescence, flow cytometry and Western blotting. Head and neck squamous cell carcinoma diagnosis, staging and prognosis can be evaluated early and accurately by sFas and sFas-L expression levels detection.

Comparison of Co-phenylcaine Spray or Lidocaine/Epinephrine Nasal Packing for Flexible Laryngoscopy

Background Nasal preparation prior to flexible laryngoscopy is a common ENT practice. Co-phenylcaine is increasingly used because it is safe and has both anaesthetic and vasoconstrictive properties. Lidocaine 4% and epinephrine 1:1000 nasal packing is another method used in our department. Methods A prospective case series was performed on eighty-one patients requiring flexible laryngoscopy. Patients were enrolled into either a co-phenylcaine or a lidocaine/epinephrine packing group. Visual analogue scales (VAS) were used to record unpleasantness of nasal preparation and flexible laryngoscopy. Decongestion and ease of endoscope passage were recorded by the doctors. Results Bad taste was statistically significantly worse when using cophenylcaine for nasal preparation ( P = 0.001). However, there was no statistically significant difference in overall unpleasantness from nasal preparation or from subsequent flexible laryngoscopy between the two groups. There was no statistically significant difference in degree of decongestion or ease of endoscope passage between the two groups. Conclusion There is no statistically significant advantage of using cophenylcaine spray over non-proprietary lidocaine 4% and epinephrine 1:1000 nasal packing. However cost and bad taste is less with nasal packing.

Use of the Nd-YAG Laser for Inferior Turbinectomy: A comparative study

Nasal obstruction resulting from inferior turbinate hypertrophy was treated by Nd-YAG laser inferior turbinectomy (laser IT). The effectiveness of the procedure was assessed and compared with both functional endoscopic turbinoplasty (turbinoplasty) and conventional partial turbinectomy (conventional IT). Materials and methods A retrospective analytic study was carried out for 53 patients suffering from inferior turbinate hypertrophy. Twenty patients underwent Nd-YAG Laser IT (Group 1), 24 patients underwent turbinoplasy (Group 2) and 9 patients underwent conventional IT (Group 3). Improvement in nasal symptoms were assessed. Intra-operative bleeding, duration of hospital stay, and post-operative medications and instrumentation were compared between the three groups. Results The symptoms of sneezing, hyposmia and rhinorhoea were significantly reduced post-operatively among patients in the three groups and there were no differences statistically between them. The Nd-YAG laser turbinectomy group showed marked reduction in blood loss (average = 12 ml per patient) compared to the turbinoplasy group (average = 181 ml per patient) and conventional IT group (average 201 ml per patient). Hospital stay was much shorter in the laser IT group (average = 0.05 days) compared to Group 2 (1.2 days) and Group 3 (1.3 days). Only one patient in the laser IT group required nasal packing, whereas all patients in the other two groups required nasal packing routinely. Conclusions Nd-YAG laser IT was effective in reducing the symptoms of nasal obstruction, as well as other nasal symptoms without significant complications. The Nd-YAG laser is recommended as an alternative method, when applicable, in treating patients with nasal obstruction resulting from inferior turbinate hypertrophy.

Nanobacteria: An Infectious Cause for Salivary Stone Formation and Recurrence

Nanobacteria (NB) contribute to pathological calcification in the human and animal body. It has been isolated from salivary stones and suggested that it may act as a nucleus for the initiation of these stones. In the present study, we examined its role in the recurrent salivary gland stones using immunodetection with NB-specific monoclonal antibodies and scanning electron microscopy (SEM) hoping to provide a method for preventing the recurrence of these stones in the patient that has suffered from salivary stones. Our study comprised 30 patients with recurrent salivary gland stones (group I) and 30 patients with salivary gland stones for the first time (group II), in addition to 30 normal controls (group III). We could detect 100–500 nm nanoparticles in 24/30 (80%) cases in group I with significant difference <0.05 and <0.01 when compared with group II and group III in which they were detected in 19/30 (63.3%) and 6/30 (20%) respectively. Also there was a significant difference <0.05 between group II and group III. We proposed that salivary stone formation is a nanobacterial disease initiated by bacterial infection. This bacteria may play an important role in the recurrence of salivary stone. So the use of calcium chelator, ethylene diamine tetra acetic acid (EDTA), before or in combination with the suitable antibiotic that is given in an amount effective to inhibit or prevent the growth and development of nanobacteria may eradicate these stones and prevent their recurrence.

Hemangioma of the Thyroid

Introduction Thyroid hemangioma is very rare, and only a few cases have previously been reported. We encountered a patient with thyroid hemangioma diagnosed after surgery. Case Report A 71-year-old woman visited our hospital with a mass in the left thyroid region. A 5-cm, elastic mass of the thyroid was palpable in the left anterior neck. On cytology by fine-needle aspiration (FNA), the specimen mainly contained blood components without apparent atypical cells. A tumor with abundant blood flow was suspected based on Doppler ultrasonography. Adenomatous goiter was suspected, and subtotal thyroidectomy was performed. A blood clot was present in the tumor, and hemangioma was diagnosed on postoperative histopathological examination. Discussion Preoperative diagnosis of thyroid hemangioma is difficult. However, Doppler ultrasonography and FNA are useful for diagnosis. A differential diagnosis of hemangioma should be considered when blood flow is abundant and only blood components are collected.

The Role of sFas in the Immune Escape Mechanism and Progression of Cancer Larynx

This work assess serum levels of soluble Fas form (sFas) in patients with different stages of laryngeal squamous cell carcinoma(LSCC) to investigate its prognostic significance. We correlate its levels with the morphological changes of peripheral blood cells via buffy coat examinatin. The study population included 70 patients clinically diagnosed and pathohistologically confirmed LSCC in addition to 20 healthy controls. According to TNM classification 33(47.1%) patients were in stage I (group I) and 24(34.3%) in stage II (group II), 13(18.5%) in stage III (group III). The results revealed that the mean serum level of sFas (pg/ml) in the control group was 51.2, in group I was 66.33, in group II was 81.33 and in group III was 112.45. Statistical analysis of the mean of sFas by ELISA test in the patients' groups in comparison to the control revealed a significant increase of both group II and III in comparison to the control group (P < 0.01) but there was no significant difference (P > 0.05) between group I in comparison to either the control or group II. There was a significant difference (P < 0.05) between group I in comparison to group III. LM examination revealed massive extent of the apoptotic cells in group III when compared to both group I and group II. EM examination of the buffy coat revealed apoptotic changes, mainly in the peripheral blood mononuclear cells (PBMNCs), represented by surface membrane ruffles and blebs with clumped nuclear chromatin and vacuolated cytoplasm. In conclusion, this study may help us to better understand one of the escape mechanisms in cancer larynx. This mechanism is represented by the significant increase in both the serum level of sFas and the morphological apoptotic changes that detected in PBMNCs. Soluble Fas may contribute to the progression of laryngeal cancer. It can be used as an attractive target for anticancer therapy and may be considered as a marker of disease progression and poor prognosis in laryngeal cancer.

Biomarkers for Cancers of the Head and Neck

Head and neck cancer is a broad term used to describe malignancies that arise in the nasal and oral cavities, pharynx and larynx, as well as the paranasal sinuses. Head and neck squamous cell carcinoma (HNSCC) affects the squamous epithelium of the oral cavity, tongue and oropharynx, excluding the nasopharynx. Recent advances in molecular technology, including gene expression and proteomic profiling appear to offer the potential for the development of specific biomarkers including diagnostic tools which may act as an aid to guide therapy for this malignancy. The other human head and neck cancer included in this review, nasopharyngeal carcinoma (NPC) is a malignancy derived from the undifferentiated epithelium of the nasopharyngeal cavity, and is considered here as a separate entity because its strong association with Epstein-Barr virus (EBV) presents the opportunity for the development of virus related and unrelated biomarkers. In particular, IgA antibodies to EBV and high levels of EBV DNA in serum samples of NPC patients have been recorded. This review aims to summarize some current and also potential new biomarkers that could be used for screening, diagnosis, monitoring and prognostic prediction for cancers of the head and neck, including NPC and HNSCC.

Pyolaryngocoele: Management of an Unusual Cause of Odynophagia and Neck Swelling

We present a case of 82 years old female with two-week history of neck swelling, odynophagia, hoarseness and cough. There was a tender, fluctuant swelling below the mandible on right side. An urgent C.T scan showed it to be a pyolaryngocele. High dose intra venous antibiotic, analgesia and nasogastric feeding resolved the acute infective episode. The residual laryngocele was treated by an excision via an external approach. A pyolaryngocele is a rare complication of laryngocele that becomes secondarily infected. It can cause feeding and respiratory compromise because of its compression symptoms. A CT is helpful for prompt diagnosis and for planning definitive surgical management. The aim of this paper is to highlight the need to recognise and then treat these cases aggressively. The best treatment option is to remove the laryngocele in-toto to prevent recurrence.