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Atkova EL, Fedorov AA, Root AO, Krakhovetsky NN, Yartsev VD. Morphological features of regenerative processes after dacryocystorinostomy with the use of mitomycin C. Orbit 2023; 42:496-501. [PMID: 36263626 DOI: 10.1080/01676830.2022.2135115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/06/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE To study the morphological features of regenerative processes in dynamics after dacryocystorinostomy (DCR) with the use of Mitomycin C (MMC). METHODS The study includes 31 cases. All patients underwent endonasal endoscopic DCR. Group 1 included 16 cases who received MMC injections. Group 2 included 15 cases who were treated with MMC on collagen sponge into the area of formed anastomosis. Biopsies for histological examination were taken on the 2nd, 5th, 7th, 14th, 21st, 28th and 60th days after the surgery. The samples were subjected to histological examination. RESULTS Activated fibroblasts were detected in patients of group 2 on the 5th day after the surgery which became the main cellular elements by the 14th day, and incomplete fibroblast mitoses were observed in group 1 by the 14th day. On the 28th day after the surgery, the transformation of the extracellular matrix into loose connective tissue was determined in patients of group 2, while single cellular elements represented by fibroblasts were preserved in biopsies obtained from patients of group 1. By the 60th day after the surgery, the restoration of a full-fledged epithelial lining was observed in all specimens. CONCLUSION With the injection of MMC, inhibition of collagenogenesis by depression of extracellular collagen matrix formation, production of abortive mitoses in cells and inhibition of maturation and transformation of fibroblasts occur. The regeneration process takes place after MMC injection under a relative decrease in fibroblast impact.
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Affiliation(s)
- Eugenia L Atkova
- Lacrimal pathology department, Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - Anatoliy A Fedorov
- Fundamental research in ophthalmology laboratory, Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - Anna O Root
- Outpatient clinic, Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - Nikolay N Krakhovetsky
- Lacrimal pathology department, Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - Vasily D Yartsev
- Lacrimal pathology department, Scientific Research Institute of Eye Diseases, Moscow, Russia
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Lehmann AE, Scangas GA, Jafari A, Banks CG, Fullerton ZH, Metson R. Predictors of long‐term success and failure in primary and revision endoscopic dacryocystorhinostomy. Int Forum Allergy Rhinol 2020; 10:374-380. [DOI: 10.1002/alr.22483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Ashton E. Lehmann
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of Otolaryngology‒Head and Neck SurgeryMassachusetts Eye and Ear Boston MA
| | - George A. Scangas
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of Otolaryngology‒Head and Neck SurgeryMassachusetts Eye and Ear Boston MA
| | - Aria Jafari
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of Otolaryngology‒Head and Neck SurgeryMassachusetts Eye and Ear Boston MA
| | - Catherine G. Banks
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of Otolaryngology‒Head and Neck SurgeryMassachusetts Eye and Ear Boston MA
| | | | - Ralph Metson
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of Otolaryngology‒Head and Neck SurgeryMassachusetts Eye and Ear Boston MA
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Atkova EL, Astrakhantsev AF, Fedorov AA, Rein DA, Krakhovetsky NN, Yartsev VD. [The nasal mucosa and outcomes of dacryocystorhinostomy]. Arkh Patol 2019; 81:24-28. [PMID: 31006776 DOI: 10.17116/patol20198102124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the impact of the nasal mucosa on the outcomes of dacryocystorhinostomy on the basis of morphologic findings. MATERIAL AND METHODS The investigation enrolled 73 patients who had undergone endonasal endoscopic dacryocystorhinostomy. Nasal mucosal biopsies were intraoperatively taken from all the patients. The obtained samples were subjected to standard histological examination, as well as to immunohistochemical study using an anti-alpha-smooth muscle actin antibody. To determine the intensity of inflammation in the tissue sample, a chronic inflammation score was calculated. The cell elements positively stained with α-smooth muscle actin were estimated using a semi-automatic method. The patients were divided into groups in accordance with the outcome of surgical treatment after 6 months. RESULTS An unfavorable outcome of dacryocystorhinostomy was observed in 10 (13.7%) patients. The samples obtained from the patients showed a higher chronic inflammation score (8.33%) and a larger number of the cell elements positively stained with α-smooth muscle actin (6026.38±1944.29). The correlation between the outcome of surgical intervention and the quantitative characteristics of myofibroblasts was statistically significant (p<0.05). CONCLUSION These studies suggest that there is a direct correlation of the efficiency of endonasal endoscopic dacryocystorhinostomy with the presence and degree of chronic nasal mucosal inflammation at baseline.
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Affiliation(s)
- E L Atkova
- Research Institute of Eye Diseases, Moscow, Russia
| | - A F Astrakhantsev
- N.A. Semashko Central Clinical Hospital Two, OAO 'RZhD', Moscow, Russia
| | - A A Fedorov
- Research Institute of Eye Diseases, Moscow, Russia
| | - D A Rein
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - V D Yartsev
- Research Institute of Eye Diseases, Moscow, Russia
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At'kova EL, Subbot AM, Krakhovetskiy NN, Yartsev VD, Rein DA. [Influence of fibrosis mediators on the outcomes of endoscopic endonasal dacryocystorhinostomy]. Vestn Oftalmol 2019; 135:19-26. [PMID: 31573553 DOI: 10.17116/oftalma201913504119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Fibrosis is the most important pathologic condition involved in undesirable outcomes of dacryocystorhinostomy. A number of biochemical factors are currently known to have an effect on wound healing by promoting excessive scarring. Isoforms of transforming growth factor β (TGF-β1) are considered the 'main' pro-fibrotic factor, but wound healing is also affected by other cytokines such as connective tissue growth factor (CTGF), which stimulates fibrosis, and fibroblast growth factor (FGF-2), which acts as antagonist to it. PURPOSE To investigate correlations between endoscopic endonasal dacryocystorhinostomy outcomes and certain mediators of fibrosis. MATERIAL AND METHODS The study included 45 cases of endoscopic endonasal dacryocystorhinostomy. The patients were grouped according to surgery outcome: patients with unsuccessful surgical treatment were assigned to group 1 (n=10); patients with successful surgical treatment - to group 2 (n=34). One patient was excluded from the study. Full-layer biopsy specimen were taken from patients' nasal mucosa before the surgery. TGF-β1, TGF-β2, TGF-β3, CTGF, FGF-2 concentrations were evaluated using ELISA and normalized by total protein concentration. RESULTS Surgical failure was observed in 10 cases (22.72%). CTGF concentration was significantly correlated with negative outcome (p<0.05) and was elevated in most specimen obtained from group 1. No significant correlation was noted between the concentrations of other evaluated cytokines in nasal mucosa specimens and the surgical outcome. CONCLUSION The study found a correlation between CTGF concentration in nasal mucosa and dacryocystorhinostomy outcome, which supports the hypothesis suggested by several authors linking dacryocystorhinostomy failure with chronic inflammation in nasal mucosa.
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Affiliation(s)
- E L At'kova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A M Subbot
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N N Krakhovetskiy
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - V D Yartsev
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - D A Rein
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Yoo JH, Kim CZ, Nam KY, Lee SU, Lee JH, Lee SJ. Correlation between nasal mucosal thickness around the lacrimal sac fossa and surgical outcomes in endonasal dacryocystorhinostomy. KOSIN MEDICAL JOURNAL 2018. [DOI: 10.7180/kmj.2018.33.3.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives To identify the relationship between surgical success rate and preoperative nasal mucosal thickness around the lacrimal sac fossa, as measured using computed tomography. Methods We reviewed 33 eyes from 27 patients who underwent endoscopic dacryocystorhinostomy after diagnosis of primary nasolacrimal duct obstruction and who were followed-up with for at least six months between 2011 and 2014. We measured preoperative nasal mucosal thickness around the bony lacrimal sac fossa using computed tomography and analyzed patient measurements after classifying them into three groups: the successfully operated group, the failed operation group, and the non-operated group. Results Surgery failed in six of the 33 eyes because of a granuloma at the osteotomy site and synechial formation of the nasal mucosa. The failed-surgery group showed a clinically significantly greater decrease in nasal mucosal thickness at the rearward lacrimal sac fossa compared with the successful-surgery group. However, nasal mucosal thickness of fellow eyes (i.e., non-operated eyes) was not significantly different between the two groups, and the location of the uncinate process did not appear to influence mucosal thickness. In the failed group, posteriorly located mucosal thickness of operated eye fossa was thinner than that of the non-operated eyes, but not significantly so. Conclusions Our results from this quantitative anatomical study suggest that nasal mucosal thickness is a predictor of endoscopic dacryocystorhinostomy results.
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Park J, Lee J, Baek S. Pathologic features and expression of heat shock protein 47 in the nasal mucosa and lacrimal sac: does it influence the surgical outcome of endoscopic endonasal dacryocystorhinostomy? Eye (Lond) 2018; 32:1432-1439. [PMID: 29773884 DOI: 10.1038/s41433-018-0115-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/07/2018] [Accepted: 04/10/2018] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To correlate the pathologic features and heat shock protein 47 (HSP47) expression in the nasal mucosa and lacrimal sac with the surgical outcomes of endoscopic endonasal dacryocystorhinostomy (EDCR). METHODS Specimens of the nasal mucosa and lacrimal sac over the rhinostomy site were collected during the operation. Haematoxylin-eosin and immunohistochemical staining were performed to determine the pathologic features (inflammation, fibrosis, squamous metaplasia) and the expression of HSP47 in the epithelium and sub-epithelial glands of the nasal mucosa and lacrimal sac. The success or failure of EDCR was determined 6 months after surgery. RESULTS A total of 30 patients (30 eyes) were included in this study. Inflammation and squamous metaplasia of the nasal mucosa were not associated with the surgical outcome of EDCR (p = 0.485 and 0.069, respectively), but there was an association with fibrosis of the nasal mucosa (p = 0.003). In addition, HSP47 in the nasal mucosa was associated with the surgical outcomes (p = 0.005). Inflammation of the lacrimal sac was not associated with the surgical outcome of EDCR (p = 0.509), but fibrosis and squamous metaplasia of the lacrimal sac were (p = 0.005 and 0.008, respectively). Additionally, HSP47 in the lacrimal sac was associated with surgical outcomes (p < 0.001). CONCLUSION Fibrosis and squamous metaplasia of the nasal mucosa and lacrimal sac lowered the success rate of EDCR. HSP47 also lowered the surgical success rate. Fibrosis was correlated with the expression of HSP47.
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Affiliation(s)
- Jinhwan Park
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Joonsik Lee
- Yesan Seoul Eye Clinic, Yesan-gun, Chungcheongnam-do, Korea
| | - Sehyun Baek
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.
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At'kova EL, Reyn DA, Yartsev VD, Subbot AM. [Influence of TGF-β cytokine and a number of other biochemical factors on regenerative process]. Vestn Oftalmol 2017; 133:89-96. [PMID: 28980572 DOI: 10.17116/oftalma2017133489-96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Scarring is one of the main causes of surgical failure in a number of eye diseases, dacryologic conditions in particular. The process of wound healing, including postoperative wound healing, goes through several stages mediated by various biochemical factors, such as growth factors and pro- and anti-inflammatory cytokines. The balance between the latter directly influences the wound healing. However, current data on the effect of these factors on postoperative outcomes are few and contradictory. Thus, in dacryology as well as in other areas of ophthalmology, the role of cytokines and growth factors in healing of surgical wounds is being intensively researched.
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Affiliation(s)
- E L At'kova
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russia, 119021
| | - D A Reyn
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russia, 119021
| | - V D Yartsev
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russia, 119021
| | - A M Subbot
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russia, 119021
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Penttilä E, Smirnov G, Tuomilehto H, Kaarniranta K, Seppä J. Endoscopic dacryocystorhinostomy as treatment for lower lacrimal pathway obstructions in adults: Review article. ALLERGY & RHINOLOGY 2015; 6:12-9. [PMID: 25860166 PMCID: PMC4388871 DOI: 10.2500/ar.2015.6.0116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Obstruction of the lacrimal pathway is manifested by epiphora, infection, and blurred vision as well as ocular and facial pain. Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice. Dacryocystorhinostomy (DCR) is recognized as the most suitable treatment for patients with obstructions of the lacrimal system at the level of the sac or in the nasolacrimal duct. The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity. During the past 2 decades, advances in rigid endoscopic equipment and other instruments have made it possible to obtain more information about the anatomic landmarks of the nasolacrimal system, which led to the development of less-invasive and safer endoscopic techniques. However, many parts of the treatment process related to endoscopic endonasal dacryocystorhinostomy (EN-DCR) still remain controversial. This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.
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Affiliation(s)
- Elina Penttilä
- Department of Otorhinolaryngology, and University of Eastern Finland, and Kuopio University Hospital, Finland
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Analysis of age as a possible prognostic factor for transcanalicular multidiode laser dacryocystorhinostomy. J Ophthalmol 2014; 2014:913047. [PMID: 25002973 PMCID: PMC4070536 DOI: 10.1155/2014/913047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/14/2014] [Accepted: 05/20/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose. To assess the prognostic value of age on the outcome of transcanalicular multidiode laser dacryocystorhinostomy (TCL-DCR) in patients with acquired nasolacrimal duct obstruction (NLDO). Methods. The medical records of TCL-DCR performed between March 2009 and September 2013 were reviewed retrospectively. Inclusion criteria include over 20 years of age, similar mean follow-up period, and similar mean duration of stenting. The main outcome is surgical success. The effect of age on success rate is also evaluated. Results. The anatomical success was 52% in Group 1 (20-30 years), 56% in Group 2 (31-40 years), 64% in Group 3 (41-50 years), 76% in Group 4 (51-60 years), and 88% in Group 5 (over 60 years). The statistical difference among Group 1 and Group 5, in terms of surgical success rate, was found to be significant (P = 0.009). Additionally, the 20-30-year-old patients had a failure rate 6.76 times higher than that of the over-60-year-old patients (P = 0.009; 95% CI, 1.605-28.542). Conclusion. TCL-DCR is a surgical treatment option for NLDO for which a skin incision can be avoided. The success rate of TCL-DCR for younger population is lower when compared with elderly population.
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Penttilä E, Hyttinen JM, Hytti M, Kauppinen A, Smirnov G, Tuomilehto H, Seppä J, Nuutinen J, Kaarniranta K. Upregulation of inflammatory genes in the nasal mucosa of patients undergoing endonasal dacryocystorhinostomy. Clin Ophthalmol 2014; 8:799-805. [PMID: 24851037 PMCID: PMC4010629 DOI: 10.2147/opth.s50195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Epiphora is a common complaint of nasolacrimal duct obstruction (NLDO) in adults. The precise pathogenesis of NLDO is still unknown, but inflammatory processes are believed to be predisposing factors. Endoscopic dacryocystorhinostomy (EN-DCR) is an effective surgical technique for treating symptomatic NLDO. The purpose of the procedure is to relieve the patient’s symptoms by creating an opening, ie, a rhinostoma, between the lacrimal sac and the nasal cavity. Although the success rates after EN-DCR are high, the procedure sometimes fails due to onset of a fibrotic process at the rhinostomy site. The aim of this prospective comparative study was to investigate inflammation-related gene expression in the nasal mucosa at the rhinostomy site. Methods Ten participants were consecutively recruited from eligible adult patients who underwent primary powered EN-DCR (five patients) or septoplasty (five controls). Nasal mucosa specimens were taken from the rhinostomy site at the beginning of surgery for analysis of gene expression. Specimens were taken from the same site on the lateral nasal wall for controls. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was performed for the inflammatory genes interleukin (IL)-6, IL-1β, and CCL2, and because of a clear trend of increased inflammation in the EN-DCR samples, a wider PCR array was performed to compare inflammation-related gene expression in EN-DCR subjects and corresponding controls. Results Our qRT-PCR results revealed a clear trend of increased transcription of IL-6, IL-1β, and CCL2 (P=0.03). The same trend was also evident in the PCR array, which additionally revealed notable differences between EN-DCR subjects and controls with regard to expression of several other inflammation-related mediators. At 6-month follow-up, the success rate after primary EN-DCR was 60%, ie, in three of five patients. Conclusion The present study demonstrates that there is an intense inflammation gene expression response in the nasal mucosa of patients undergoing EN-DCR.
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Affiliation(s)
- Elina Penttilä
- Department of Otorhinolaryngology, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland
| | - Juha Mt Hyttinen
- Department of Ophthalmology, Institute of Clinical Medicine, University of Eastern Finland
| | - Maria Hytti
- Department of Ophthalmology, Institute of Clinical Medicine, University of Eastern Finland
| | - Anu Kauppinen
- Department of Ophthalmology, Institute of Clinical Medicine, University of Eastern Finland ; Department of Ophthalmology, Kuopio University Hospital, Kuopio, Finland
| | - Grigori Smirnov
- Department of Otorhinolaryngology, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland ; Oivauni Sleep Clinic, Kuopio, Finland
| | - Henri Tuomilehto
- Department of Otorhinolaryngology, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland ; Oivauni Sleep Clinic, Kuopio, Finland
| | - Juha Seppä
- Department of Otorhinolaryngology, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland
| | - Juhani Nuutinen
- Department of Otorhinolaryngology, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland
| | - Kai Kaarniranta
- Department of Ophthalmology, Institute of Clinical Medicine, University of Eastern Finland ; Department of Ophthalmology, Kuopio University Hospital, Kuopio, Finland
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Mak ST, Io IYF, Wong ACM. Prognostic factors for outcome of endoscopic dacryocystorhinostomy in patients with primary acquired nasolacrimal duct obstruction. Graefes Arch Clin Exp Ophthalmol 2012; 251:1361-7. [DOI: 10.1007/s00417-012-2228-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/23/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022] Open
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Pasaje CFA, Bae JS, Park BL, Cheong HS, Kim JH, Jang AS, Uh ST, Park CS, Shin HD. Possible role of EMID2 on nasal polyps pathogenesis in Korean asthma patients. BMC MEDICAL GENETICS 2012; 13:2. [PMID: 22217332 PMCID: PMC3398310 DOI: 10.1186/1471-2350-13-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 01/04/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Since subepithelial fibrosis and protruded extracellular matrix are among the histological characteristics of polyps, the emilin/multimerin domain-containing protein 2 (EMID2) gene is speculated to be involved in the presence of nasal polyps in asthma and aspirin-hypersensitive patients. METHODS To investigate the association between EMID2 and nasal polyposis, 49 single-nucleotide polymorphisms (SNPs) were genotyped in 467 asthmatics of Korean ancestry who were stratified further into 114 aspirin exacerbated respiratory disease (AERD) and 353 aspirin-tolerant asthma (ATA) subgroups. From pairwise comparison of the genotyped polymorphisms, 14 major haplotypes (frequency > 0.05) were inferred and selected for association analysis. Differences in the frequency distribution of EMID2 variations between polyp-positive cases and polyp-negative controls were determined using logistic analyses. RESULTS Initially, 13 EMID2 variants were significantly associated with the presence of nasal polyps in the overall asthma group (P = 0.0008-0.05, OR = 0.54-1.32 using various modes of genetic inheritance). Although association signals from 12 variants disappeared after multiple testing corrections, the relationship between EMID2_BL1_ht2 and nasal polyposis remained significant via a codominant mechanism (P corr = 0.03). On the other hand, the nominal associations observed between the genetic variants tested for the presence of nasal polyps in AERD (P = 0.003-0.05, OR = 0.25-1.82) and ATA (P = 0.01-0.04, OR = 0.46-10.96) subgroups disappeared after multiple comparisons, suggesting lack of associations. CONCLUSIONS These preliminary findings suggest that EMID2_BL1_ht2 may be a susceptibility marker of inflammation of the nasal passages among Korean asthma patients.
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Penttilä E, Smirnov G, Seppa J, Kaarniranta K, Tuomilehto H. Mitomycin C in Revision Endoscopic Dacryocystorhinostomy: A Prospective Randomized Study. Am J Rhinol Allergy 2011; 25:425-8. [DOI: 10.2500/ajra.2011.25.3676] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Endoscopic dacryocystorhinostomy (EN-DCR) is an effective and safe procedure when treating saccal and postsaccal nasolacrimal duct obstruction. However, sometimes scarring of the rhinostomy site caused by fibrosis may occur, particularly in revision operations. The application of intraoperative mitomycin C (MMC), an antiproliferative agent, has been introduced as one possible technique to improve the outcome. We conducted a prospective, randomized study to evaluate if the use of MMC improves the success in endonasal revision DCR procedure. Methods Thirty revision EN-DCR procedures were performed during 2004–2010. The patients were randomized into two study groups, according to whether the intraoperative MMC was used or not. The technique of EN-DCR procedure in both groups was the same, but in the MMC group, at the end of the procedure a piece of tampon soaked in MMC (0.4 mg/mL) was placed into the rhinostoma for 5 minutes. No silicone stents were inserted. The surgical outcome at the 6-month follow-up visit was considered successful if the lacrimal sac irrigation succeeded and if the patients’ symptoms were relieved. Results The success rate after revision EN-DCR with MMC was 93% and without MMC was 60%. The overall success rate was 77%. The difference between the two groups was not statistically significant (p = 0.08). The relief of the symptoms between groups in both the Nasolacrimal Duct Obstruction Symptom Score and ocular symptoms was statistically significant (p = 0.007 and p = 0.02, respectively). Conclusion The results of our study indicate that the application of intraoperative mitomycin C may improve the outcome in revision EN-DCR.
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Affiliation(s)
- Elina Penttilä
- Department of Otorhinolaryngology, Institute of Clinical Medicine, Kuopio University Hospital, and University of Eastern Finland, Finland
| | - Grigori Smirnov
- Department of Otorhinolaryngology, Institute of Clinical Medicine, Kuopio University Hospital, and University of Eastern Finland, Finland
| | - Juha Seppa
- Department of Otorhinolaryngology, Institute of Clinical Medicine, Kuopio University Hospital, and University of Eastern Finland, Finland
| | - Kai Kaarniranta
- Department of Ophthalmology, Institute of Clinical Medicine, Kuopio University Hospital, and University of Eastern Finland, Finland
| | - Henri Tuomilehto
- Department of Otorhinolaryngology, Institute of Clinical Medicine, Kuopio University Hospital, and University of Eastern Finland, Finland
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