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Tessler I, Shemesh R, Sherman G, Soudry E, Chen SCA, Ziv O, Kordeluk S, Bar-On D, Novikov I, Yakirevitch A. Impact of azole antifungal treatment on outcome in acute invasive fungal rhinosinusitis with orbitocranial involvement: a surgical perspective. Rhinology 2023; 61:561-567. [PMID: 37566791 DOI: 10.4193/rhin23.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
PURPOSE To provide real-life data on azole treatment outcomes and the role of surgery in the current management of invasive fungal rhinosinusitis complicated by orbitocranial fungal infection (OCFI). METHODS Data was collected retrospectively from a chart review from four participating centers and a systematic literature review. The study group included patients with OCFI treated with azole antifungals. The control cases were treated with other antifungal agents. The cranial and orbital involvement degree was staged based on the imaging. The extent of the surgical resection was also classified to allow for inter-group comparison. RESULTS There were 125 patients in the azole-treated group and 153 in the control group. Among the patients with OCFI cranial extension, 23% were operated on in the azole-treated group and 18% in the control group. However, meninges and brain resection were performed only in the controls (11% of patients) and never in the azole antifungals group. Orbital involvement required surgery in 26% of azole-treated cases and 39% of controls. Despite a more aggressive cranial involvement, azole-treated patients' mortality was significantly lower than in controls, with an OCFI-specific mortality rate of 21% vs. 52%. A similar, though not statistically significant, trend was found for the extent of the orbital disease and surgery. CONCLUSION Despite less aggressive surgical intervention for cranial involvement, OCFI patients treated with azoles had a higher survival rate. This finding suggests we may improve morbidity with a more conservative surgical approach in conjunction with azole treatment. The same trend is emerging for orbital involvement.
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Affiliation(s)
- I Tessler
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Shemesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - G Sherman
- Pediatric Infectious Diseases Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
| | - E Soudry
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Israel
| | - S C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, Australia and Sydney Medical School, The University of Sydney, Australia
| | - O Ziv
- Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - S Kordeluk
- Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - D Bar-On
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Israel
| | - I Novikov
- Biostatistics and Biomathematics unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Israel
| | - A Yakirevitch
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rozendorn N, Yakirevitch A, Glikson E, Landsberg R, Ritter A, Mozzanica F, Schneider S, Soudry E. The implications of concomitant mucosal inflammation on clinical manifestations and outcomes of sinonasal inverted papilloma. Eur Arch Otorhinolaryngol 2023; 280:4963-4968. [PMID: 37452833 DOI: 10.1007/s00405-023-08088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE This study examines the impact of concomitant mucosal inflammation on clinical manifestations and long-term outcomes of Inverted Papilloma (IP). METHODS This retrospective cohort study was conducted in five tertiary medical centers. The included patients underwent an attachment-oriented surgical resection for IP with a minimum follow-up of 3 years. RESULTS Of 185 patients with IP, 65 patients (35.1%) had synchronous mucosal inflammation with polypoid changes. The mean age was 56.7 years, and 69% were males. Most tumors originated from the maxillary sinus. Age, gender, Krouse stage, and tumor attachment site did not differ between the mucosal inflammation and IP-only groups. IP recurrence rate was twofold in the patients with mucosal inflammation (15.4% vs. 7.5%, p = 0.092). However, the difference was not significant, with a similar median time to recurrence between the two groups [15.5 (3-36) months vs. 16(6-96) months, p = 0.712]. In revision cases, IP recurred only in patients with mucosal inflammation (19% vs. 0%, p = 0.07). This group had a significantly worse 5-years recurrence-free survival than revision cases without mucosal inflammation (80.6% vs. 100%, p = 0.04). CONCLUSIONS IP in the setting of mucosal inflammation might be associated with a higher recurrence rate, predominantly after revision surgery. Otolaryngologists should consider this during these patients' diagnosis, surgical planning, and follow-up.
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Affiliation(s)
- Noa Rozendorn
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.
| | - Arkadi Yakirevitch
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Glikson
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roee Landsberg
- ARM Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Amit Ritter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Francesco Mozzanica
- Department of Otorhinolaryngology, Ospedale San Giuseppe IRCCS Multimedica, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Shay Schneider
- ARM Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Ethan Soudry
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
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Rozendorn N, Warman M, Zloczower E, Mansour J, Yakirevitch A. Significance of nasal septal deviation among patients with antrochoanal polyp. J Laryngol Otol 2023; 137:921-924. [PMID: 36515175 DOI: 10.1017/s0022215122002614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to examine the association between nasal septal deviation and antrochoanal polyp. METHODS This was a retrospective review of medical records and imaging of patients who underwent endoscopic sino-nasal surgery for antrochoanal polyp. RESULTS Forty-eight patients operated on for antrochoanal polyp between 2009 and 2019 were eligible for the study. The median age was 32 years, and 52.1 per cent were male. Antrochoanal polyp was diagnosed equally in the right and left nasal cavities. Septal deviation was present in 77 per cent of such cases. In 44 per cent of septal deviation cases, the antrochoanal polyp was ipsilateral to the deviation, which was not statistically significant. The type of deviation according to the Mladina classification was not correlated with the laterality of septal deviation and antrochoanal polyp. CONCLUSION The laterality of the septal deviation was not found to be correlated with that of the antrochoanal polyp. Therefore, performing routine septoplasty during antrochoanal polyp surgery is unnecessary unless the deviation interferes with the complete extraction of the polyp.
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Affiliation(s)
- N Rozendorn
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - M Warman
- Department of Otolaryngology - Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - E Zloczower
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - J Mansour
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - A Yakirevitch
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
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Gimmon Y, Izhak Duvdevani S, Wolfovitz A, Shapira Y, Sagiv D, Yakirevitch A. [SLEEP HABIT MODIFICATION AS A POSSIBLE PREVENTION OF RECURRENT BENIGN PAROXYSMAL POSITIONAL VERTIGO]. Harefuah 2023; 162:440-443. [PMID: 37561034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) is effectively treated with a variety of repositioning maneuvers but one-third to one-half of patients experience recurrence, usually within 2 years after the first attack. OBJECTIVES The aim of this study was to investigate possible prevention of recurrent BPPV by sleep habit modification. METHODS Patients diagnosed with posterior semicircular canal BPPV (p-BPPV) were asked their preferred lying side during nocturnal sleep. Following Epley maneuver they were recommended to change their head lying side at least every 2 hours during nocturnal sleep and to come back in case of recurrence. RESULTS A total of 266 patients were diagnosed with p-BPPV. The mean patient's age was 57 years (range 14-87 years). There were 167 patients with right p-BPPV and 99 patients with left p-BPPV; 134 (50%) patients habitually slept on the right side. Of those, 112 (84%) were diagnosed with right p-BPPV (P= 0.0006); 87 patients (33%) habitually slept on the left side; 56 of them (64%) were diagnosed with left p-BPPV (P <0.0001). Among the 45 patients (17%) who expressed no preference concerning their sleeping positions, the right versus left p-BPPV was nearly even. During the follow-up period (1-80 months, mean 41) 11 patients (4%) were diagnosed with recurrent p-BPPV. Of those, 9 had a recurrence in the same posterior semicircular canal and 2 in the contralateral one. All of them reported that they had not modified their sleep habits. CONCLUSIONS The results of our study can shed some light on the etiology of BPPV and may be helpful in preventing recurrent BPPV by changing sleep-position habits.
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Affiliation(s)
- Yoav Gimmon
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel, Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, Haifa University, Israel
| | - Shay Izhak Duvdevani
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Wolfovitz
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yisgav Shapira
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Sagiv
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arkadi Yakirevitch
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shemesh R, Yakirevitch A, Abergel A, Leibovitch I, Ben Simon GJ, Ben Cnaan R. Endoscopic approach for orbital apex lesions: case series and review of the literature. J Laryngol Otol 2023; 137:419-425. [PMID: 35678382 DOI: 10.1017/s0022215122001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The transnasal endoscopic approach may provide better visualisation and a safer approach to the orbital apex. This study presents a case series of orbital apex lesions managed by this approach. METHOD This study was an eight-year retrospective analysis of seven patients who were operated on for orbital apex lesions in two tertiary medical centres. RESULTS Complete tumour removal was performed in three patients and partial removal was performed in four patients. Visual acuity improved in three patients, remained stable in one patient and decreased in the other two patients. The visual field improved in four patients and did not change in two patients. Complications included worse vision and visual fields in 28.6 per cent of patients and late enophthalmos (of -1.25 ± 4.6 mm) in 2 patients. CONCLUSION The transnasal approach to orbital apex lesions in selected cases may provide a rational alternative to transorbital surgery. Complete tumour removal should be weighed against the risk of damage to the optic nerve.
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Affiliation(s)
- R Shemesh
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Goldschleger Eye Institute, Ramat Gan, Israel
| | - A Yakirevitch
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - A Abergel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology - Head and Neck Surgery, Tel Aviv, Israel
| | - I Leibovitch
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - G J Ben Simon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Goldschleger Eye Institute, Ramat Gan, Israel
| | - R Ben Cnaan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Alfi O, Hamdan M, Wald O, Yakirevitch A, Wandel O, Oiknine-Djian E, Gvili B, Knoller H, Rozendorn N, Golan Berman H, Adar S, Vorontsov O, Mandelboim M, Zakay-Rones Z, Oberbaum M, Panet A, Wolf DG. SARS-CoV-2 Omicron Induces Enhanced Mucosal Interferon Response Compared to other Variants of Concern, Associated with Restricted Replication in Human Lung Tissues. Viruses 2022; 14:v14071583. [PMID: 35891570 PMCID: PMC9318963 DOI: 10.3390/v14071583] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 Omicron variant has been characterized by decreased clinical severity, raising the question of whether early variant-specific interactions within the mucosal surfaces of the respiratory tract could mediate its attenuated pathogenicity. Here, we employed ex vivo infection of native human nasal and lung tissues to investigate the local-mucosal susceptibility and innate immune response to Omicron compared to Delta and earlier SARS-CoV-2 variants of concern (VOC). We show that the replication of Omicron in lung tissues is highly restricted compared to other VOC, whereas it remains relatively unchanged in nasal tissues. Mechanistically, Omicron induced a much stronger antiviral interferon response in infected tissues compared to Delta and earlier VOC-a difference, which was most striking in the lung tissues, where the innate immune response to all other SARS-CoV-2 VOC was blunted. Notably, blocking the innate immune signaling restored Omicron replication in the lung tissues. Our data provide new insights to the reduced lung involvement and clinical severity of Omicron.
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Affiliation(s)
- Or Alfi
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; (O.A.); (M.H.); (O.W.); (E.O.-D.); (O.V.)
- Department of Biochemistry, Institute for Medical Research Israel Canada, Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel; (Z.Z.-R.); (A.P.)
- Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel
| | - Marah Hamdan
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; (O.A.); (M.H.); (O.W.); (E.O.-D.); (O.V.)
| | - Ori Wald
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Arkadi Yakirevitch
- Department of Otorhinolaryngology, Sheba Medical Center, Ramat Gan 52621, Israel; (A.Y.); (B.G.); (H.K.); (N.R.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ori Wandel
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; (O.A.); (M.H.); (O.W.); (E.O.-D.); (O.V.)
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; (O.A.); (M.H.); (O.W.); (E.O.-D.); (O.V.)
| | - Ben Gvili
- Department of Otorhinolaryngology, Sheba Medical Center, Ramat Gan 52621, Israel; (A.Y.); (B.G.); (H.K.); (N.R.)
| | - Hadas Knoller
- Department of Otorhinolaryngology, Sheba Medical Center, Ramat Gan 52621, Israel; (A.Y.); (B.G.); (H.K.); (N.R.)
| | - Noa Rozendorn
- Department of Otorhinolaryngology, Sheba Medical Center, Ramat Gan 52621, Israel; (A.Y.); (B.G.); (H.K.); (N.R.)
| | - Hadar Golan Berman
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel; (H.G.B.); (S.A.)
| | - Sheera Adar
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel; (H.G.B.); (S.A.)
| | - Olesya Vorontsov
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; (O.A.); (M.H.); (O.W.); (E.O.-D.); (O.V.)
- Department of Biochemistry, Institute for Medical Research Israel Canada, Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel; (Z.Z.-R.); (A.P.)
- Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel
| | - Michal Mandelboim
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan 52621, Israel;
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Zichria Zakay-Rones
- Department of Biochemistry, Institute for Medical Research Israel Canada, Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel; (Z.Z.-R.); (A.P.)
| | - Menachem Oberbaum
- The Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Jerusalem 9103102, Israel;
| | - Amos Panet
- Department of Biochemistry, Institute for Medical Research Israel Canada, Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel; (Z.Z.-R.); (A.P.)
| | - Dana G. Wolf
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; (O.A.); (M.H.); (O.W.); (E.O.-D.); (O.V.)
- Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel
- Correspondence:
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Katz U, Nakache G, Alon EE, Yakirevitch A. Applicability of Transnasal Echography for Identification of Internal Carotid Artery. Laryngoscope 2022; 132:1184-1188. [PMID: 35191043 DOI: 10.1002/lary.30055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To study the applicability of transnasal echography for the internal carotid artery (ICA) imaging during endoscopic procedures, primarily nasopharyngectomy. STUDY DESIGN Non-randomized controlled cohort. METHODS The tip of a pediatric transducer for transesophageal echography was inserted into each nostril under endoscopic control and placed in the ipsilateral Rosenmuller's fossa. The ICA's internal diameter and distance between the nasopharyngeal wall and the artery's closest point were measured on each side. Two independent examiners measured the same parameters on the axial plane of the skull base computer tomography (CT). Agreement between CT and echography measurements was estimated by the Bland-Altman approach. RESULTS Twenty-seven ICAs (sides) were available for the echography-CT agreement analysis. Inter method agreement for both parameters was similar to the inter examiner agreement for the CT measurements. CONCLUSIONS Our first study on endoscopic echography demonstrated that this method is applicable, potentially allowing safer transnasal surgery in the ICA vicinity. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Uriel Katz
- Pediatric Heart Institute, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Nakache
- Department of Otolaryngology, Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Eran E Alon
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Otolaryngology, Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Arkadi Yakirevitch
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Otolaryngology, Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
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8
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Alfi O, Yakirevitch A, Wald O, Wandel O, Izhar U, Oiknine-Djian E, Nevo Y, Elgavish S, Dagan E, Madgar O, Feinmesser G, Pikarsky E, Bronstein M, Vorontsov O, Jonas W, Ives J, Walter J, Zakay-Rones Z, Oberbaum M, Panet A, Wolf DG. Human Nasal and Lung Tissues Infected Ex Vivo with SARS-CoV-2 Provide Insights into Differential Tissue-Specific and Virus-Specific Innate Immune Responses in the Upper and Lower Respiratory Tract. J Virol 2021; 95:e0013021. [PMID: 33893170 PMCID: PMC8223920 DOI: 10.1128/jvi.00130-21] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/20/2021] [Indexed: 12/25/2022] Open
Abstract
The nasal mucosa constitutes the primary entry site for respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While the imbalanced innate immune response of end-stage coronavirus disease 2019 (COVID-19) has been extensively studied, the earliest stages of SARS-CoV-2 infection at the mucosal entry site have remained unexplored. Here, we employed SARS-CoV-2 and influenza virus infection in native multi-cell-type human nasal turbinate and lung tissues ex vivo, coupled with genome-wide transcriptional analysis, to investigate viral susceptibility and early patterns of local mucosal innate immune response in the authentic milieu of the human respiratory tract. SARS-CoV-2 productively infected the nasal turbinate tissues, predominantly targeting respiratory epithelial cells, with a rapid increase in tissue-associated viral subgenomic mRNA and secretion of infectious viral progeny. Importantly, SARS-CoV-2 infection triggered robust antiviral and inflammatory innate immune responses in the nasal mucosa. The upregulation of interferon-stimulated genes, cytokines, and chemokines, related to interferon signaling and immune-cell activation pathways, was broader than that triggered by influenza virus infection. Conversely, lung tissues exhibited a restricted innate immune response to SARS-CoV-2, with a conspicuous lack of type I and III interferon upregulation, contrasting with their vigorous innate immune response to influenza virus. Our findings reveal differential tissue-specific innate immune responses in the upper and lower respiratory tracts that are specific to SARS-CoV-2. The studies shed light on the role of the nasal mucosa in active viral transmission and immune defense, implying a window of opportunity for early interventions, whereas the restricted innate immune response in early-SARS-CoV-2-infected lung tissues could underlie the unique uncontrolled late-phase lung damage of advanced COVID-19. IMPORTANCE In order to reduce the late-phase morbidity and mortality of COVID-19, there is a need to better understand and target the earliest stages of SARS-CoV-2 infection in the human respiratory tract. Here, we have studied the initial steps of SARS-CoV-2 infection and the consequent innate immune responses within the natural multicellular complexity of human nasal mucosal and lung tissues. Comparing the global innate response patterns of nasal and lung tissues infected in parallel with SARS-CoV-2 and influenza virus, we found distinct virus-host interactions in the upper and lower respiratory tract, which could determine the outcome and unique pathogenesis of SARS-CoV-2 infection. Studies in the nasal mucosal infection model can be employed to assess the impact of viral evolutionary changes and evaluate new therapeutic and preventive measures against SARS-CoV-2 and other human respiratory pathogens.
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Affiliation(s)
- Or Alfi
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Department of Biochemistry, IMRIC, The Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, The Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Arkadi Yakirevitch
- Department of Otolaryngology—Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Wald
- Department of Cardiothoracic Surgery, Hadassah University Hospital, Jerusalem, Israel
| | - Ori Wandel
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Uzi Izhar
- Department of Cardiothoracic Surgery, Hadassah University Hospital, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yuval Nevo
- Bioinformatics Unit of the I-CORE Computation Center, The Hebrew University and Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Sharona Elgavish
- Bioinformatics Unit of the I-CORE Computation Center, The Hebrew University and Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Elad Dagan
- Department of Otolaryngology—Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ory Madgar
- Department of Otolaryngology—Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Feinmesser
- Department of Otolaryngology—Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Pikarsky
- Lautenberg Center for General and Tumor Immunology, The Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Michal Bronstein
- Center for Genomic Technologies, Alexander Silberman Institute of Life Sciences, Hebrew University, Jerusalem, Israel
| | - Olesya Vorontsov
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Department of Biochemistry, IMRIC, The Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, The Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Wayne Jonas
- Samueli Institute, Alexandria, Virginia, USA
| | - John Ives
- Samueli Institute, Alexandria, Virginia, USA
| | - Joan Walter
- Samueli Institute, Alexandria, Virginia, USA
| | - Zichria Zakay-Rones
- Department of Biochemistry, IMRIC, The Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Menachem Oberbaum
- The Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Amos Panet
- Department of Biochemistry, IMRIC, The Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Dana G. Wolf
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, The Hebrew University Faculty of Medicine, Jerusalem, Israel
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9
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Shemesh R, Ben Simon GJ, Bedrin L, Yakirevitch A. Minimally Invasive Surgery of Orbital Apex. Isr Med Assoc J 2020; 22:800. [PMID: 33381956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Rachel Shemesh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy J Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lev Bedrin
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Department of Otorhinolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Arkadi Yakirevitch
- Department of Otorhinolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Glikson E, Dragonetti A, Soudry E, Rozendoren N, Landsberg R, Bedrin L, Mozzanica F, Schneider S, Yakirevitch A. Can Computed Tomography Findings Predict the Recurrence of Sinonasal Inverted Papilloma? Otolaryngol Head Neck Surg 2020; 164:1116-1121. [PMID: 33048600 DOI: 10.1177/0194599820964798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the correlation between the ability to predict the attachment site of sinonasal inverted papilloma by computed tomography and the long-term surgical outcome. STUDY DESIGN Retrospective cohort study. SETTING Five tertiary medical centers. METHODS Study patients underwent attachment-oriented resection of inverted papilloma. The primary outcome was tumor recurrence. RESULTS Among 195 patients eligible for the study, focal hyperostosis was recognized on computed tomography in 65% (n = 127), in 71% of primary cases (n = 101), and in 50% of revision procedures (n = 26). There was a trend for a higher incidence of squamous cell carcinoma among the patients without detectable hyperostosis (P = .051). Location of hyperostosis coincided with the actual tumor attachment site in 114 patients (90%). Discordance between these parameters did not differ significantly (P = .463) between 11 primary and 2 revision cases. The overall rate of recurrence was 9.7% (n = 19), with a mean time to recurrence of 20 months (range, 7-96 months). The rate of recurrence did not correlate with any of the following: tumor stage, surgical approach, presence of squamous cell carcinoma, whether the surgery was primary or revision, and the presence or location of focal hyperostosis on computed tomography. Inverted papilloma recurred significantly more often (38.5%) when the intraoperative findings of the tumor attachment site did not match the location of hyperostosis observed on computed tomography (odds ratio, 6.5; 95% CI, 1.78-23.66). CONCLUSION Detectability of focal hyperostosis on preoperative computed tomography does not affect the long-term outcome of inverted papilloma resection.
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Affiliation(s)
- Eran Glikson
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ethan Soudry
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Noa Rozendoren
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Roee Landsberg
- ARM Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Lev Bedrin
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Francesco Mozzanica
- Department of Otorhinolaryngology, Ospedale San Giuseppe IRCCS Multimedica, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Shay Schneider
- ARM Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Arkadi Yakirevitch
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Yousovich R, Duvdevani SI, Lipschitz N, Wolf M, Migirov L, Yakirevitch A. Correlation Between the Sleep-Position Habits and the Affected Posterior Semicircular Canal in Patients with Benign Paroxysmal Positional Vertigo. Isr Med Assoc J 2019; 21:716-718. [PMID: 31713357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. It is assumed that sleep is involved in the pathogenesis of BPPV, and that habitual head-lying side during sleep correlates with the affected side in the posterior semicircular canal BPPV. OBJECTIVES To investigate the relationship between the preferred sleeping position and the affected semicircular canal in patients with BPPV. METHODS We performed a retrospective data review of patients seeking help for vertigo/dizziness who had undergone clinical evaluation including a Dix-Hallpike test. Patients diagnosed with posterior canal BPPV (p-BPPV) were asked to define their preferred lying side (right, left, supine, or variable) during the night sleep. Affected semicircular canal (right posterior or left posterior) was registered along with demographic data. RESULTS In all, 237 patients were diagnosed with p-BPPV. Patients with horizontal semicircular canal BPPV (n=11) were excluded. Patient mean age was 57 years (range 14-87). There were 150 patients with right p-BPPV and 87 patients with left p-BPPV. Among the patients, 122 (52%) habitually slept on the right side. Of those, 102 (84%) were diagnosed with right p-BPPV (P = 0.0006), while 82 patients (34%) habitually slept on the left side. Fifty-three (65%) were diagnosed with left p-BPPV (P < 0.0001). There were no differences in right vs. left p-BPPV in the 33 patients (14%) who expressed no preference concerning their sleeping positions. CONCLUSIONS Our study highlights the etiology of BPPV and showed that changing sleep position habits might be helpful in preventing recurrent BPPV.
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Affiliation(s)
- Ruth Yousovich
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay I Duvdevani
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noga Lipschitz
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Wolf
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lela Migirov
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arkadi Yakirevitch
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Preti A, Mozzanica F, Gera R, Gallo S, Zocchi J, Bandi F, Guidugli G, Ambrogi F, Yakirevitch A, Schindler A, Dragonetti A, Castelnuovo P, Ottaviani F. Horizontal lateral lamella as a risk factor for iatrogenic cerebrospinal fluid leak. Clinical retrospective evaluation of 24 cases. Rhinology 2019. [PMID: 29785412 DOI: 10.4193/rhin18.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Several authors highlighted the limitations of the Keros classification system in predicting intracranial entry risk. Recently, our group proposed a new classification system based on the angle formed between the lateral lamella of the cribriform plate (LLCP) and the continuation of an horizontal plane passing through the cribriform plate (Gera classification). The aim of this study was to analyze whether the risk of iatrogenic cerebrospinal fluid leak (CSF-L) was better predicted by Keros or Gera classification. METHODOLOGY The pre-operative CT scans of 24 patients (CSF-L group) who suffered from iatrogenic CSF-L during endoscopic sinus surgery (ESS) were compared to those obtained from a group of 100 patients who underwent uneventful ESS (control group). The skull base measurements as well as the distribution of Keros and Gera classes in the 2 groups were analyzed. RESULTS No difference in the distribution of Keros classes or in the depth of the cribriform plate between CSF-L and control group were demonstrated. On the contrary, significant differences in the distribution of Gera classes and in the degree of the angle formed by the LLCP and the continuation of the horizontal plane passing through the cribriform plate were found. In particular, according to Gera classification system, 19 out of 24 patients in the CSF-L group were considered at risk for iatrogenic CSF-L. CONCLUSIONS Gera classification system might be more sensitive to anatomical variations associated with CSF-L than the Keros one, further suggesting the application of the former during the preoperative CT scan evaluation.
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Affiliation(s)
- A Preti
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - F Mozzanica
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - R Gera
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - S Gallo
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - J Zocchi
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - F Bandi
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - G Guidugli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - F Ambrogi
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - A Yakirevitch
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - A Schindler
- Department of Biochemical and Clinical science Luigi Sacco, University of Milan, Milan, Italy
| | - A Dragonetti
- Department of Otolaryngology, Ospedale Niguarda, Milan, Italy
| | - P Castelnuovo
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - F Ottaviani
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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13
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Preti A, Mozzanica F, Gera R, Gallo S, Zocchi J, Bandi F, Guidugli G, Ambrogi F, Yakirevitch A, Schindler A, Dragonetti A, Castelnuovo P, Ottaviani F. Horizontal lateral lamella as a risk factor for iatrogenic cerebrospinal fluid leak. Clinical retrospective evaluation of 24 cases. Rhinology 2018; 56:358-363. [PMID: 29785412 DOI: 10.4193/rhin.18.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Several authors highlighted the limitations of the Keros classification system in predicting intracranial entry risk. Recently, our group proposed a new classification system based on the angle formed between the lateral lamella of the cribriform plate (LLCP) and the continuation of an horizontal plane passing through the cribriform plate (Gera classification). The aim of this study was to analyze whether the risk of iatrogenic cerebrospinal fluid leak (CSF-L) was better predicted by Keros or Gera classification. METHODOLOGY The pre-operative CT scans of 24 patients (CSF-L group) who suffered from iatrogenic CSF-L during endoscopic sinus surgery (ESS) were compared to those obtained from a group of 100 patients who underwent uneventful ESS (control group). The skull base measurements as well as the distribution of Keros and Gera classes in the 2 groups were analyzed. RESULTS No difference in the distribution of Keros classes or in the depth of the cribriform plate between CSF-L and control group were demonstrated. On the contrary, significant differences in the distribution of Gera classes and in the degree of the angle formed by the LLCP and the continuation of the horizontal plane passing through the cribriform plate were found. In particular, according to Gera classification system, 19 out of 24 patients in the CSF-L group were considered at risk for iatrogenic CSF-L. CONCLUSIONS Gera classification system might be more sensitive to anatomical variations associated with CSF-L than the Keros one, further suggesting the application of the former during the preoperative CT scan evaluation.
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Affiliation(s)
- A Preti
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - F Mozzanica
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - R Gera
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - S Gallo
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - J Zocchi
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - F Bandi
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - G Guidugli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - F Ambrogi
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - A Yakirevitch
- Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - A Schindler
- Department of Biochemical and Clinical science Luigi Sacco, University of Milan, Milan, Italy
| | - A Dragonetti
- Department of Otolaryngology, Ospedale Niguarda, Milan, Italy
| | - P Castelnuovo
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - F Ottaviani
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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14
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Glikson E, Chavkin U, Madgar O, Sagiv D, Nakache G, Yakirevitch A, Wolf M, Alon EE. Epistaxis in the setting of antithrombotic therapy: A comparison between factor Xa inhibitors, warfarin, and antiplatelet agents. Laryngoscope 2018; 129:119-123. [DOI: 10.1002/lary.27400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Eran Glikson
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
| | | | - Ory Madgar
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
| | - Doron Sagiv
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
| | - Gabriel Nakache
- Department of Otolaryngology-Head and Neck Surgery; Rabin Medical Center; Petach Tikva Israel
| | - Arkadi Yakirevitch
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michael Wolf
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Eran E. Alon
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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15
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Slonimsky G, Slonimsky E, Yakirevitch A, Sagiv D, Duvdevani S, Talmi Y, Wolf M, Alon E. The significance of Computed Tomography in invasive paranasal mucormycosis. Rhinology 2018; 56:54-58. [DOI: 10.4193/rhin17.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Lipschitz N, Yakirevitch A, Sagiv D, Migirov L, Talmi YP, Wolf M, Alon EE. Nasal vestibulitis: etiology, risk factors, and clinical characteristics: A retrospective study of 118 cases. Diagn Microbiol Infect Dis 2017; 89:131-134. [PMID: 28780999 DOI: 10.1016/j.diagmicrobio.2017.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/07/2017] [Accepted: 06/12/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nasal vestibulitis (NV) is a common infection; however, scant data is available in the literature as it pertains to NV. We aim to describe the clinical characteristics of NV in respect to its potential complications. METHODS A retrospective chart review of 118 NV cases admitted to a tertiary medical center between 2008 and 2015. RESULTS Identified risk factors for NV included nasal hair plucking (n=15, 14.41%), nose blowing (n=10, 9.32%), nose picking (n=9, 8.47%) and nose piercing (n=5, 3.39%). Twelve patients (10.17%) were diabetic, and 3 patients were immunosuppressed. Mid-facial cellulitis was observed in the majority of patients (78.81%), and abscess of the nasal vestibule was observed in almost half (48.30%). Cultures were taken from 33.33% of patients demonstrated MSSA as the most common isolate (81.25%). No complications were observed. CONCLUSION Even in complicated cases of NV requiring admission, the risk of major complications is extremely low.
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Affiliation(s)
- Noga Lipschitz
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel.
| | - Arkadi Yakirevitch
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Sagiv
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Lela Migirov
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav P Talmi
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Wolf
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran E Alon
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Sagiv D, Witt RL, Glikson E, Mansour J, Shalmon B, Yakirevitch A, Wolf M, Alon EE, Slonimsky G, Talmi YP. Warthin tumor within the superficial lobe of the parotid gland: a suggested criterion for diagnosis. Eur Arch Otorhinolaryngol 2016; 274:1993-1996. [PMID: 28013343 DOI: 10.1007/s00405-016-4436-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Abstract
The location of Warthin tumor (WT) in the parotid gland impacts the surgical approach and may be indicative of the elusive origin of this intriguing entity. Location in the deep versus superficial lobe of the gland is not directly addressed when defining WT characteristics. Our observation, of rare occurrence of deep lobe WT, if at all, led to the current investigation. The study design is cohort study. This is a retrospective chart review of all patients undergoing parotidectomy for WT in two tertiary academic referral centers: the Sheba Medical Center (SMC), Israel, and the Christiana Care (CC), Newark, Delaware, USA. 122 consecutive adult patients underwent parotidectomy for WT (72 from SMC and 50 from CC). Seventy percent were males, with a mean age of 60.6 years. Bilateral WT or multi-centric WT were found in 9.8 and 17.2% of the cases, respectively. In one case, the tumor was described as originating in the deep lobe. In all other cases, the tumor originated and was limited to the superficial lobe. 99.2% of WT originated in the superficial lobe, corresponding with the few reports directly addressing its location in the gland. The reason for the tumor to be limited almost uniformly to the superficial lobe is unknown, and could be related to the etiopathogenesis of this elusive entity. We suggest adding tumor location within the superficial lobe to the common characteristics of WT (male, smoking, and lower pole) that serve as "common criterion" while evaluating a parotid lesion.
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Affiliation(s)
- Doron Sagiv
- Department of Otolaryngology Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Robert L Witt
- Otolaryngology-Head and Neck Surgery, Christiana Care, Newark, Delaware/Thomas Jefferson University, Philadelphia, PA, USA
| | - Eran Glikson
- Department of Otolaryngology Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Jobran Mansour
- Department of Otolaryngology Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Bruria Shalmon
- Department of Pathology, The Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arkadi Yakirevitch
- Department of Otolaryngology Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Wolf
- Department of Otolaryngology Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran E Alon
- Department of Otolaryngology Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Slonimsky
- Department of Otolaryngology Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Yoav P Talmi
- Department of Otolaryngology Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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18
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Yakirevitch A, Barg AA, Bedrin L, Primov-Fever A, Wolf M, Migirov L. Acute Invasive Fungal Rhinosinusitis in Children With Hematologic Malignancies: Outcome of Surgical Treatment. Pediatr Hematol Oncol 2016; 32:568-75. [PMID: 26558653 DOI: 10.3109/08880018.2015.1092058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The incidence of acute invasive fungal rhinosinusitis (AIFR) is rising due to more aggressive chemotherapy and longer survival of immunosuppressed patients. Early diagnosis and appropriate but nonmutilating surgical treatment are particularly problematic in the pediatric population. This study aimed to evaluate the outcome of surgery for pediatric AIFR. Medical records of children surgically treated for AIFR between 1998 and 2014 were reviewed. Diagnosis was based on both histopathological and microbiological confirmation. Surgery was performed with curative intent and repeated for any resectable extension. The children underwent endoscopy and magnetic resonance imaging every 2 and 6 months, respectively, during the first postoperative year. Thirteen patients (2-18 years old) met the EORTC/MSG criteria for proven invasive fungal sinusitis; fungal invasion was diagnosed by preoperative biopsy and confirmed in the surgical specimen. All patients underwent an average of two endoscopic procedures (range 1-3), and four of them also underwent an open surgery. The local control rate was at least 79%. There was no facial disfiguration during follow-up (average 41 months). Although AIFR is still associated with high mortality, aggressive medical and surgical treatment provides local control in most cases. Fair outcome should encourage a maximal joint effort of pediatric hemato-oncologists and otorhinolaryngologists in the management of AIFR.
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Affiliation(s)
- Arkadi Yakirevitch
- a Department of Otolaryngology-Head & Neck Surgery , Sheba Medical Center , Israel.,c Sackler School of Medicine, Tel Aviv University , Israel
| | - Assaf Arie Barg
- b Department of Pediatric Hemato-Oncology , Sheba Medical Center , Israel
| | - Lev Bedrin
- a Department of Otolaryngology-Head & Neck Surgery , Sheba Medical Center , Israel
| | - Adi Primov-Fever
- a Department of Otolaryngology-Head & Neck Surgery , Sheba Medical Center , Israel.,c Sackler School of Medicine, Tel Aviv University , Israel
| | - Michael Wolf
- a Department of Otolaryngology-Head & Neck Surgery , Sheba Medical Center , Israel.,c Sackler School of Medicine, Tel Aviv University , Israel
| | - Lela Migirov
- a Department of Otolaryngology-Head & Neck Surgery , Sheba Medical Center , Israel.,c Sackler School of Medicine, Tel Aviv University , Israel
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Greenberg G, Eyal A, Yakirevitch A, Wolf M, Migirov L. Cholesteatoma and coexisting findings diagnosed incidentally on MRI. Ear Nose Throat J 2016; 95:E17-E20. [PMID: 27304447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
The explosive growth in the use of diffusion-weighted magnetic resonance imaging (MRI) in the pre- and postoperative evaluations of patients with cholesteatoma has led to a concomitant increase in the number of incidental findings in this population. We describe our retrospective examination of MRI studies in cholesteatoma patients to look for the presence of other coexisting abnormalities. We examined the brain MRIs of 103 patients-45 males and 58 females, aged 3 to 81 years (mean: 31.9 ± 21.3)-who had undergone pre- or postoperative imaging during the management of a cholesteatoma. The MRIs revealed the presence of at least one other anomaly in 79 of these patients (76.7%)-36 males and 43 females, aged 3 to 81 years (mean: 43.5 ± 18.2). These 79 MRIs detected a total of 124 lesions that had been coexisting with cholesteatomas; some of these lesions had overlapped with the cholesteatoma. The two most common findings were sinonasal mucoperiosteal thickening and polyposis (n = 66) and white-matter changes (n = 29). Our results establish the need for routine skilled interpretation of brain MRIs by expert neuroradiologists to ensure that findings coexisting with cholesteatoma are detected so that appropriate management can be provided.
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Affiliation(s)
- Gahl Greenberg
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 5262l, Israel
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20
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Affiliation(s)
- Arkadi Yakirevitch
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel 52621.
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21
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Yakirevitch A, Carmel E, Ben-Yehuda HM, Sagiv D, Wolf M, Migirov L. Predicting the outcome of peritonsillar abscess in children. B-ENT 2016; 12:181-185. [PMID: 29727121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVES peritonsillar abscess (PTA) is the most common deep neck infection in children. The causes of its development and recurrence are not fully understood. The aim of this study was to investigate the predictive factors of PTA outcome such as recurrent tonsillitis, recurrent/residual PTA and interval tonsillectomy in children. METHODOLOGY retrospective study of surgically confirmed paediatric PTA case series in one medical centre (1997-2007). Anamnestic, clinical and laboratory parameters of primary PTA were compared with recurrent cases. RESULTS thirteen 13 of the 8 1 enrolled patients (16 %) had had PTA previously. Their incidence of trismus and percentage of neutrophils in peripheral blood were lower than in the primary cases. Past history of PTA, a positive pus culture and type of pathogen did not influence outcome. CONCLUSION no evaluated factor was found to be definitive for predicting PTA outcome. The clinical presenation of a recurrent PTA may be less severe in appearance than in a primary case.
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Yakirevitch A, Bedrin L, Nakache G. Variations in Lateral Sphenoid Sinus Wall Defects. IJNS 2015. [DOI: 10.1055/s-0035-1558962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Arkadi Yakirevitch
- Department of Otolaryngology, Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Israel
| | - Lev Bedrin
- Department of Otolaryngology, Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Israel
| | - Gabriel Nakache
- Department of Otolaryngology, Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Israel
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Migirov L, Lipschitz N, Slonimsky G, Yakirevitch A, Wolf M. Efficacy of myringoplasty in older people. Aging Clin Exp Res 2014; 26:661-4. [PMID: 24789218 DOI: 10.1007/s40520-014-0221-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
Abstract
The aim of current investigation was to analyze the efficacy of myringoplasty in an elderly population. The medical records of 12 males and 9 females, aged 65-90 years (mean 70.7 years), who underwent myringoplasty between 2007 and 2013 were retrospectively reviewed for age, gender, co-morbidities, perforation size and location, pre- and postoperative pure tone averages of air/bone thresholds at 500, 1,000, 2,000 and 3,000 Hz, graft material, postoperative complications and surgical outcome. The most frequent co-morbidities included hypertension (n = 8), hyperlipidemia (n = 7), diabetes mellitus (n = 5) and ischemic heart disease (n = 4). Fifteen patients had two or more co-morbidities. All surgeries were performed via a trans-canal approach. Seventeen patients had central perforations and four patients had marginal perforations. Temporalis fascia, perichondrium or chondro-perichondrial graft and fat were used as grafting material in 9, 11 and 1 patient, respectively. The post-operative complications were infection (n = 4) and tragal seroma (n = 1). Surgical outcome was successful in 16/21 patients with graft take rates of 89, 72 and 0% for temporalis fascia, perichondrium/cartilage, and fat, respectively. Pre-operative audiometric data were available for all 21 patients; however, the post-operative data were available for only 15 of them. Myringoplasty in older people was a safe procedure with a 76.2% surgical success rate in the current study. The choice of graft material, perforation size, gender and associated co-morbidities had no significant effect on achieving an intact tympanic membrane and a dry ear. The audiometric results did not show significant changes following myringoplasty.
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Migirov L, Yakirevitch A, Wolf M. The utility of minimally invasive transcanal endoscopic approach for removal of residual/recurrent cholesteatoma: preliminary results. Eur Arch Otorhinolaryngol 2014; 272:3241-6. [PMID: 25413019 DOI: 10.1007/s00405-014-3402-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/17/2014] [Indexed: 12/28/2022]
Abstract
To investigate the feasibility of applying the transcanal endoscopic approach (TEA) for surgical treatment of residual/recurrent cholesteatoma and present the preliminary results of 17 revision procedures that were carried out with this minimally invasive approach. The records of 17 patients (aged 5-76 years) who underwent transcanal revision procedure using rigid 3-mm diameter, 0°, 30° and 45° endoscopes between 2009 and 2012 were retrospectively reviewed. A wide posterior tympanomeatal flap was elevated via the external auditory canal and then transposed inferiorly in cases of cholesteatoma situated in the middle ear under a tympanic membrane. In certain cases, cholesteatoma was assessed and removed using the endoscopes directly from the radical cavity or from the mastoid cavity remaining after a canal-wall-down procedure. Six patients had originally undergone the canal-wall-up mastoidectomy, 6 patients had a canal-wall-down mastoidectomy and 5 patients had radical mastoid cavities. The interval between the previous and the index surgery ranged between 1 and 6 years. The attic was the most common site involved with cholesteatoma, followed by the tympanic portion of the facial nerve, sinus tympani, mastoid, supratubal recess, promontory, round and oval windows. The size of residual/recurrent lesion varied between 3 and 15 mm. The patients were followed up 26-67 months (mean 52.1 months). The single recurrence (a 4-mm pearl over the tympanic portion of the facial nerve) was eradicated by a transcanal re-revision 1 year following the index surgery. Minimally invasive TEA can be successfully applied in carefully selected patients with endoscopically accessible cholesteatoma subsequent to various types of mastoidectomy.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, 5262l, Tel Aviv, Israel.
| | - Arkadi Yakirevitch
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, 5262l, Tel Aviv, Israel
| | - Michael Wolf
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, 5262l, Tel Aviv, Israel
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Duvdevani SI, Migirov L, Wolf M, Yakirevitch A. The rate of spontaneous epistaxis is not linked to the lunar cycle but shows seasonal variations. Chronobiol Int 2014; 31:851-4. [DOI: 10.3109/07420528.2014.916298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Alon EE, Lipschitz N, Bedrin L, Gluck I, Talmi Y, Wolf M, Yakirevitch A. Delayed Sino-nasal Complications of Radiotherapy for Nasopharyngeal Carcinoma. Otolaryngol Head Neck Surg 2014; 151:354-8. [PMID: 24732689 DOI: 10.1177/0194599814530858] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/18/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There are only sporadic reports of delayed sino-nasal complications associated with nasopharyngeal carcinoma (NPC) treated with radiotherapy. These include choanal stenosis, osteoradionecrosis, chronic sinusitis, and intranasal synechiae. Most likely, these complications are underestimated as in many institutions nasal endoscopies in NPC patients are not performed routinely. The aim of this study was to identify the onset and incidence of delayed sino-nasal complications in NPC patients and their effect on quality of life (QOL). STUDY DESIGN Case series with chart review. SETTING Tertiary medical center. SUBJECTS AND METHODS A retrospective chart review was performed on all patients treated for NPC in our institution between 1988 through 2009. The inclusion criteria required at least a 3-year follow-up without recurrence. Included patients were contacted prospectively and asked to fill a SNOT-16 questionnaire. RESULTS Sixty-two patients were included in our review. There were 42 males and 20 females. The average age at onset was 42 years. The AJCC staging for T1, T2, T3, and T4 tumors was 22 (35%), 11 (18%), 18 (29%), and 11 (18%), respectively. Eleven patients (18%) suffered from chronic sinusitis. Nine patients (15%) developed choanal stenosis. Five patients (8%) developed osteoradionecrosis. Two patients suffered from nasal synechiae. Forty-eight patients completed the SNOT-16 questionnaire. Patients with choanal stenosis had the lowest QOL scores out of the cohort. CONCLUSION The incidence of delayed sino-nasal complications after radiation treatment for NPC is not negligible and should be kept in mind when addressing the quality of life of NPC survivors.
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Affiliation(s)
- Eran E Alon
- Department of Otolaryngology Head and Neck Surgery, the Chaim Sheba Medical Central, Tel Hashomer and the Tel Aviv University, Israel
| | - Noga Lipschitz
- Department of Otolaryngology Head and Neck Surgery, the Chaim Sheba Medical Central, Tel Hashomer and the Tel Aviv University, Israel
| | - Lev Bedrin
- Department of Otolaryngology Head and Neck Surgery, the Chaim Sheba Medical Central, Tel Hashomer and the Tel Aviv University, Israel
| | - Iris Gluck
- Department of Oncology, the Chaim Sheba Medical Center, Tel Hashomer and the Tel Aviv University, Israel
| | - Yoav Talmi
- Department of Otolaryngology Head and Neck Surgery, the Chaim Sheba Medical Central, Tel Hashomer and the Tel Aviv University, Israel
| | - Michael Wolf
- Department of Otolaryngology Head and Neck Surgery, the Chaim Sheba Medical Central, Tel Hashomer and the Tel Aviv University, Israel
| | - Arkadi Yakirevitch
- Department of Otolaryngology Head and Neck Surgery, the Chaim Sheba Medical Central, Tel Hashomer and the Tel Aviv University, Israel
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Abstract
Unilateral nasal masses are considered suspicious for proliferative diseases. Several tools are routinely used to investigate unilateral lesions such as imaging and nasal biopsy. This study investigated the usefulness of nasal biopsy in predicting the actual nature of unilateral lesions. Preoperative nasal biopsy pathological results were compared with the final pathology obtained during an operation. Forty-six patients with unilateral nasal masses were included in the study group. In 40 patients the final pathology was similar to the preoperative nasal biopsy. In three patients the biopsy specimen was a benign polyp and the final pathology was of an inverted papilloma in two patients and hemangiopericytoma in one patient. In two patients the biopsy specimen was suspicious for an inverted papilloma and the final pathology was a benign polyp. In one patient the biopsy specimen was chordoma and the final pathology was osteosarcoma. The total agreement was 86.9%. The kappa value was 81.2%. Preoperative nasal biopsy is important and useful in evaluating unilateral nasal masses.
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Affiliation(s)
- Nili Segal
- Faculty of Health Sciences Ben-Gurion University, Soroka University Medical Center, Beer Sheva, Israel
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Yakirevitch A, Lipschitz N, Alon EE, Yudovich K, Wolf M, Bedrin L. Delayed Sinonasal Complications of Radiotherapy for Nasopharyngeal Carcinoma. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813495815a84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: There are only sporadic reports of delayed sinonasal complications associated with nasopharyngeal carcinoma (NPC) treated with radiotherapy. These include choanal stenosis, osteoradionecrosis, chronic sinusitis, and intranasal synechiae. The aim of this study was to identify the time of onset and incidence of complications associated with the treatment of NPC and to compare them to the extent of the primary tumor and radiation dose. Methods: A retrospective chart review was performed on all patients who presented to our institution between 1988 through 2009 and who were diagnosed and treated for NPC. The inclusion criteria required at least a 3-year follow-up. Excluded were patients with disease recurrence. Furthermore, patients were contacted prospectively and were asked to complete a SNOT-16 questionnaire. Results: Sixty-four patients were included in our review. There were 43 males and 21 females. The average age at onset was 42. The T staging for T1, T2, T3, and T4 were 22, 11, 18, and 11 respectively. There were no T staging data for one patient. Two patients suffered from synechiae, which required synechiolysis. Five patients developed osteoradionecrosis and underwent debridement. Ten patients developed choanal stenosis, and it was repaired in 2. Ten patients suffered from sinusitis. Four of those required functional endoscopic sinus surgery. Conclusions: The incidence of delayed sinonasal complications of NPC radiotherapy is not negligible, and they should be kept in mind both for the informed consent of the patients and their active detection and treatment.
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Yakirevitch A, Bedrin L, Alon EE, Yoffe T, Wolf M, Yahalom R. Relation between preoperative computed tomographic criteria of injury to the nasofrontal outflow tract and operative findings in fractures of the frontal sinus. Br J Oral Maxillofac Surg 2013; 51:799-802. [PMID: 23810457 DOI: 10.1016/j.bjoms.2013.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 06/01/2013] [Indexed: 11/17/2022]
Abstract
Injury to the nasofrontal outflow tract is important in the treatment of fractures of the frontal sinus. In 2008 preoperative computed tomographic (CT) criteria or signs of such injuries were proposed and stated to be reliable. The aim of this study was to evaluate the validity of these criteria by comparing the radiological evidence with the operative findings. Thirty-nine patients for whom the data from preoperative CT could be compared with operative findings were eligible for the study, all but 4 of whom had at least one indicator of injury to the outflow tract. Patients whose tracts were found to be obstructed at operation had at least 2 preoperative CT signs of obstruction of the tract. If the outflow tract was obstructed all 3 criteria were significantly more likely to be present than if it was intact (p=0.02). Two criteria or fewer did not correlate significantly with obstruction. Fractures were managed by reconstruction (n=18), obliteration (n=11), or cranialisation (n=10). This study is the first to our knowledge to examine the correlation between preoperative CT criteria and operative findings, and there was a significant difference in the number of criteria present depending on whether the outflow tract was intact or injured. Our findings allow for more accurate planning of management of fractures of the frontal sinus.
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Affiliation(s)
- Arkadi Yakirevitch
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
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Yakirevitch A, Nakache G, Lipschitz N, Alon EE, Wolf M, Talmi YP. Use of the vessel sealing system in tracheostomy. Isr Med Assoc J 2013; 15:275-276. [PMID: 23882889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Tracheostomy is a frequent, and at times semiurgent, surgical procedure. It is performed in close proximity to the thyroid gland, and in many cases requires division of its isthmus, putting a patient in danger of significant bleeding. OBJECTIVES To examine prospectively the feasibility of vessel sealing in tracheostomy. METHODS A vessel-seating device was used in 24 consecutive patients undergoing tracheostomy. There were no exclusion criteria for enrolling the patients. No other hemostatic technique was used for dividing the isthmus. RESULTS There were no bleeding events throughout the postoperative period. The operating time saving was 5-10 minutes. CONCLUSIONS Use of the vessel sealer was found to be straightforward, efficacious, rapid and safe.
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Affiliation(s)
- Arkadi Yakirevitch
- Department of Otorhinolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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Besser MJ, Shoham T, Harari-Steinberg O, Zabari N, Ortenberg R, Yakirevitch A, Nagler A, Loewenthal R, Schachter J, Markel G. Development of allogeneic NK cell adoptive transfer therapy in metastatic melanoma patients: in vitro preclinical optimization studies. PLoS One 2013; 8:e57922. [PMID: 23483943 PMCID: PMC3587427 DOI: 10.1371/journal.pone.0057922] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/27/2013] [Indexed: 11/19/2022] Open
Abstract
Natural killer (NK) cells have long been considered as potential agents for adoptive cell therapy for solid cancer patients. Until today most studies utilized autologous NK cells and yielded disappointing results. Here we analyze various modular strategies to employ allogeneic NK cells for adoptive cell transfer, including donor-recipient HLA-C mismatching, selective activation and induction of melanoma-recognizing lysis receptors, and co-administration of antibodies to elicit antibody-dependent cell cytotoxicity (ADCC). We show that NK cell activation and induction of the relevant lysis receptors, as well as co-administration of antibodies yield substantial anti-cancer effects, which are functionally superior to HLA-C mismatching. Combination of the various strategies yielded improved effects. In addition, we developed various clinically-compatible ex vivo expansion protocols that were optimized according to fold expansion, purity and expression of lysis receptors. The main advantages of employing allogeneic NK cells are accessibility, the ability to use a single donor for many patients, combination with various strategies associated with the mechanism of action, e.g. antibodies and specific activation, as well as donor selection according to HLA or CD16 genotypes. This study rationalizes a clinical trial that combines adoptive transfer of highly potent allogeneic NK cells and antibody therapy.
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Affiliation(s)
- Michal J. Besser
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, GreenOnyx, Israel
| | | | - Orit Harari-Steinberg
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
- Pediatric Stem Cell Research Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Naama Zabari
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, GreenOnyx, Israel
| | - Rona Ortenberg
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, GreenOnyx, Israel
| | - Arkadi Yakirevitch
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ron Loewenthal
- Tissue Typing Laboratory, Sheba Medical Center, Tel Hashomer, Israel
| | - Jacob Schachter
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
| | - Gal Markel
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, GreenOnyx, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- * E-mail:
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Drendel M, Yakirevitch A, Kerimis P, Migirov L, Wolf M. Hearing loss in bullous myringitis. Auris Nasus Larynx 2012; 39:28-30. [DOI: 10.1016/j.anl.2011.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 03/29/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
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Nicolai P, Villaret AB, Farina D, Nadeau S, Yakirevitch A, Berlucchi M, Galtelli C. Endoscopic surgery for juvenile angiofibroma: a critical review of indications after 46 cases. Am J Rhinol Allergy 2010; 24:e67-72. [PMID: 20338105 DOI: 10.2500/ajra.2010.24.3443] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND At present, transnasal endoscopic surgery is considered a viable option in the management of small-intermediate size juvenile angiofibromas (JAs). The authors critically review their 14-year experience in the management of this lesion to refine selection criteria for an endoscopic approach. METHODS From January 1994 to May 2008, 46 patients were treated by a pure endoscopic resection after vascular embolization (87%). The lesions were classified according to Andrews (Andrews JC, et al., The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach, Laryngoscope 99:429-437, 1989) and Onerci (Onerci M, et al. Juvenile nasopharyngeal angiofibroma: A revised staging system, Rhinology 44:39-45, 2006) staging systems. All patients were followed by regular endoscopic and magnetic resonance imaging (MRI) examinations. RESULTS Lesions were classified as follows: stage I, n = 5; stage II, n = 24; stage IIIa, n = 14; stage IIIb, n = 3 according to Andrews classification system; stage 1, n = 9; stage II, n = 12; stage III, n = 26 according to Onerci's system. Unilateral blood supply was detected in 39 (85%) cases. Feeding vessels from the internal carotid artery (ICA) were also reported in 14 (30%) patients. Intraoperative blood loss ranged from 250 to 1300 mL (mean, 580 mL). In four (8.7%) cases, suspicious residual disease was detected by MRI. In one patient, a 1-cm persistent lesion was endoscopically removed because septoplasty was required and a slight increase in size was noticed. The other three lesions, all located in the root of the pterygoid plate, are nearly stable in size and are currently under MRI follow-up. CONCLUSION The improvement of surgical instrumentation and the experience acquired during a 14-year period have contributed to expanding the indications for endoscopic surgery in the management of JAs. Even stage III lesions may be successfully managed, unless the ICA is encased or if it provides an extensive blood supply. An external approach may be required when critical structures such as the ICA, cavernous sinus, or optic nerve are involved by lesions that are persistent after previous treatment; such a situation may prevent safe and radical dissection with a pure endoscopic approach. Better understanding of the factors influencing the growth of residual lesions is needed to differentiate those requiring re-treatment from those which can be simply observed.
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Affiliation(s)
- Piero Nicolai
- Department of Otorhinolaryngology, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
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Villaret AB, Yakirevitch A, Bizzoni A, Bosio R, Bignami M, Pistochini A, Battaglia P, Castelnuovo P, Nicolai P. Endoscopic transnasal craniectomy in the management of selected sinonasal malignancies. Am J Rhinol Allergy 2010; 24:60-5. [PMID: 20109329 DOI: 10.2500/ajra.2010.24.3397] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Because of a better understanding of the anatomy from an endoscopic perspective, the acquisition of surgical experience, and concomitant technological advances, endoscopic resection of the anterior skull base (ASB) and overlying dura has now become a reality, opening new possibilities in the management of sinonasal malignancies. Here, the authors review a series of 62 patients, the largest reported to date, who underwent endoscopic transnasal craniectomy (ETC) and endoscopic dural repair for the management of selected sinonasal malignancies. Special emphasis is placed on the surgical technique, technical tricks, choice of materials for endoscopic dural repair, postoperative management, and complications. METHODS From 2004, 62 patients underwent ETC at two referral hospitals, which extended anteroposteriorly from the frontal sinus to planum sphenoidale and laterolaterally from the nasal septum to the lamina papyracea (unilateral resection, n = 28; 45%) or from papyracea to papyracea (bilateral resection, n = 34; 55%). Duraplasty with a three-layer technique was performed using the iliotibial tract and fat tissue. RESULTS The most frequent histotypes were adenocarcinoma (58%) and olfactory neuroblastoma (22%). Forty-five (73%) patients were previously untreated. The incidence of early (T1-2, Kadish A-B) and advanced (T3-4, Kadish C) tumors was similar. The complication rate was 15%, mostly cerebrospinal fluid leaks (13%). Its prevalence did not correlate with patient age, medical comorbidities, previous treatment, presence of ASB involvement, or whether ETC was mono- or bilateral, but tended to correlate with advanced tumor stage, dural involvement, and the period of treatment. After a mean follow-up of 17.5 months (range, 1-54 months), 58 (94%) patients had no evidence of disease. CONCLUSION In correctly selected patients with sinonasal tumors involving the ASB, ETC offers a less invasive alternative than resection by an open approach with an acceptable morbidity.
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Yakirevitch A, Bedrin L, Migirov L, Wolf M, Talmi YP. Use of alternative medicine in Israeli chronic rhinosinusitis patients. J Otolaryngol Head Neck Surg 2009; 38:517-520. [PMID: 19755095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE The worldwide interest in the use of complementary and alternative medicine (CAM) has been established in multiple surveys. Chronic rhinosinusitis (CRS) is often an unremitting disease with frequent troubling relapses, and despite wide use of endoscopic sinus surgery, conventional medicine may have a smaller contribution than expected. Because of prevalent use of CAM among patients, it is important that physicians acquire basic knowledge of this subject. We studied the prevalence of CAM use among CRS patients in Israel. DESIGN Use of CAM was evaluated in a cohort of consecutive adult patients with CRS. SETTING An outpatient clinic in a tertiary medical centre. METHODS Patients were asked to fill out an anonymous questionnaire containing demographic data and data pertaining to allergy, traditional medical and surgical treatment use of CAM, and modalities used. RESULTS Ninety patients were included. Nineteen of them (21%) reported CAM use. This included herbal medicine, vitamins, homeopathy, acupuncture, massage, reflexology, yoga, and chiropractics. There was a tendency, although not statistically significant, for patients with allergy and a history of sinus surgery to use CAM. CONCLUSIONS The prevalence of CAM use among patients with CRS in Israel is high and may correlate with the presence of allergies and a history of sinus surgery.
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Affiliation(s)
- Arkadi Yakirevitch
- Department of Otorhinolaryngology-Head and Neck Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Migirov L, Yakirevitch A, Bedrin L, Wolf M. Endoscopic sinus surgery for medial orbital subperiosteal abscess in children. J Otolaryngol Head Neck Surg 2009; 38:504-508. [PMID: 19755093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To present our experience with endoscopically managed medial orbital subperiosteal abscess (MOSA) in children and to compare the results with external drainage of the abscess. METHODS A retrospective record review was conducted on 22 children with MOSA, of whom 6 underwent drainage by endoscopic sinus surgery (group 1) and 16 underwent external ethmoidectomy (group 2). MOSA was diagnosed by computed tomography of the orbits. RESULTS There were no postoperative sequelae in children treated endoscopically, in contrast to facial scarring, delayed healing, stitch abscess, unresolved diplopia, or recurrent periorbital cellulitis with or without subperiosteal abscess following external drainage. Streptococcus pneumoniae and Haemophilus influenzae were isolated in three children and one child in group 1, respectively, whereas the cultures were negative in the other two group 1 children who received antibiotics prior to admission. Streptococcus species were also the most common isolates in group 2 (50%), followed by H. influenzae (19%). The mean duration of postoperative healing was 4.2 +/- 1.9 days (range 2-7 days) in group 1 and 8.6 +/- 4.2 days (range 5-17) in group 2 (p = .005). The mean respective hospital stay was 6.0 +/- 2.0 days (range 4-9 days) and 9.9 +/- 4.2 days (range 5-18 days) (p = .02). One group 2 child with residual disease underwent revision external ethmoidectomy 5 weeks after the initial procedure. Recurrent periorbital cellulitis was successfully managed conservatively in two group 2 children, 3 and 10 months postoperatively in one child, and 3 months and 6 years postoperatively in the other. CONCLUSION We recommend exclusive use of an endoscopic approach for treating MOSA and saving external ethmoidectomy for drainage of superior orbital abscesses.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel.
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Keshet GI, Goldstein I, Itzhaki O, Cesarkas K, Shenhav L, Yakirevitch A, Treves AJ, Schachter J, Amariglio N, Rechavi G. MDR1 expression identifies human melanoma stem cells. Biochem Biophys Res Commun 2008; 368:930-6. [PMID: 18279661 DOI: 10.1016/j.bbrc.2008.02.022] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 02/02/2008] [Indexed: 12/19/2022]
Abstract
ABC transporters are often found to be inherently expressed in a wide variety of stem cells, where they provide improved protection from toxins. We found a subpopulation of human melanoma cells expressing multidrug-resistance gene product 1 (MDR1). This fraction co-expresses the ABC transporters, ABCB5 and ABCC2 in addition to the stem cell markers, nanog and human telomerase reverse transcriptase (hTERT). The clonogenicity and self-renewal capacity of MDR1(+) melanoma cells were investigated in single cell settings using the limiting dilution assay. We found that the MDR1(+) cells, isolated by FACS sorting, demonstrated a higher self-renewal capacity than the MDR1(-) fraction, a key stem cell feature. Moreover, MDR1(+) cells had higher ability to form spheres in low attachment conditions, a hallmark of cancer. In conclusion, these novel findings imply that the MDR1(+) cells represent melanoma stem cells and thus should be considered as a unique cellular target for future anti-melanoma therapies.
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Affiliation(s)
- Gilmor I Keshet
- Cancer Research Center, Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University Tel Aviv, 52621, Israel
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Yakirevitch A, Zabari N, Schachter J, Besser MJ. R054: NK Cells Expansion and Activation for Cancer Immunotherapy. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yakirevitch A, Horowitz Z, Simansky D, Bedrin L, Kronenberg J, Talmi YP. Mediastinal dissection in head and neck cancer. J Laryngol Otol 2006; 120:865-7. [PMID: 16859569 DOI: 10.1017/s0022215106001800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2006] [Indexed: 11/07/2022]
Abstract
The superior mediastinum contains a considerable number of lymph nodes. Although occasionally involved in head and neck cancer, there are not many reports of mediastinal dissection in the practice of head and neck surgery. We present a group of seven patients with head and neck tumours that underwent mediastinal dissection in our department. Three patients are alive and free of disease six months to three years after the operation, two are alive with disease four and five years after the procedure, and two patients died peri-operatively. According to reviewed current literature, direct invasion of cancer of the head and neck to the mediastinum or mediastinal lymph node involvement is uncommon. Yet, mediastinal dissection provides the only chance for cure in selected cases.
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Affiliation(s)
- A Yakirevitch
- Department of Otolaryngology--Head and Neck Surgery, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Migirov L, Yakirevitch A, Kronenberg J. Surgical and Medical Complications following Cochlear Implantation: Comparison of Two Surgical Approaches. ORL J Otorhinolaryngol Relat Spec 2006; 68:213-9. [PMID: 16534242 DOI: 10.1159/000091817] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Accepted: 01/14/2005] [Indexed: 11/19/2022]
Abstract
Our study was designed to evaluate the complication rate of cochlear implantation (CI) and to compare two different surgical approaches that are currently being used for implantations in our department. This retrospective study was conducted on the patients who underwent CI in our center between 1989 and 2003 and who were followed-up for at least 18 months. The patients were divided into two groups according to the surgical technique that had been used for the implantation: the mastoidectomy with posterior tympanotomy approach and the suprameatal approach (without mastoidectomy). The incidence of complications following CI was compared between the two groups and between children and adults. Facial nerve paralysis, electrode misplacement, injury to the chorda tympani nerve and mastoiditis occurred only in the mastoidectomy with posterior tympanotomy approach group. Acute middle ear infection with or without mastoiditis emerged as the most common complication in both groups, followed by vestibular and wound problems. Disequilibrium was significantly more common among the adults than among the children (p < 0.0001). The suprameatal approach was demonstrated as being a good alternative technique to the classical surgery for CI.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Aviv, Israel.
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Abstract
INTRODUCTION Normal sense of smell is important for well being. Although cancer is reported to be associated with impaired olfactory function, very few studies have directly evaluated this effect. PATIENTS AND METHODS We performed a quantitative analysis of olfactory status in 42 hospice patients in a hospital-based hospice facility. Olfaction was assessed using the "Sniffin' Sticks" (Burghart Medical Technology, Tinsdaler, Germany) kit. RESULTS Twenty-five patients (60%) were found to be hyposmic. CONCLUSION Study results indicate the high incidence of decreased olfactory function among hospice patients.
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Affiliation(s)
- Arkadi Yakirevitch
- Department of Otolaryngology-Head and Neck Surgery, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Migirov L, Yakirevitch A, Henkin Y, Kaplan-Neeman R, Kronenberg J. Acute otitis media and mastoiditis following cochlear implantation. Int J Pediatr Otorhinolaryngol 2006; 70:899-903. [PMID: 16309750 DOI: 10.1016/j.ijporl.2005.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2005] [Revised: 10/02/2005] [Accepted: 10/06/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the incidence of acute otitis media (AOM) and mastoiditis in children after cochlear implantation (CI) and to evaluate the role of mastoidectomy in decreasing the rate of AOM in implanted children by comparing two surgical techniques: the Posterior tympanotomy approach (MPTA, with mastoidectomy) and the Suprameatal approach (SMA, without mastoidectomy). METHODS A retrospective study was conducted on 234 children up to 16 years of age who underwent CI between 1993 and 2003 in our department. The children were divided into two groups according to the surgical technique that had been used for the implantation: the MPTA group and the SMA group. RESULTS Part of the children with a history of pre-implantation AOM (22 of 29 in MPTA group and 26 of 38 in SMA group) did not suffer from AOM post-CI (p=0.59), and an incidence of AOM after CI in children who did not have history of AOM prior to implantation (13 patients of MPTA group and 15 patients of SMA group) was unrelated to surgical approach (p=0.65). The incidence of pre-implantation AOM was similar for the two groups and declined after CI unrelated to performing of mastoidectomy in surgical technique. Overall, 47 children (20.1%) had post-CI AOM compared to 67 children (28.6%) who had pre-CI AOM. Mastoiditis developed in 11 children (4.7%), all 11 in the MPTA group. A subperiosteal abscess was incised and drained with the retroauricular approach in three of these children and the others were managed with intravenously administered ceftriaxone 50mg/kg/day for 3-5 consecutive days, followed by a course of oral cephalexin until there is complete clinical resolution of the effusion in the middle ear. The implants were preserved in all cases. Seven out of 11 children with mastoiditis had no history of AOM prior to implantation. CONCLUSIONS AOM and mastoiditis represent common complications of CI that can be successfully treated with the prompt use of antibiotics. However, the subperiosteal abscess could require surgical drainage. In our opinion, the decrease of incidence of AOM in implanted children is the result of natural history of otitis media and is unrelated to the surgical approach.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Hashomer 5262l, Israel.
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Abstract
OBJECTIVE To present a large study on subperiosteal abscess (SA) that represents the most frequent complication of acute mastoiditis. METHOD A retrospective study was conducted on 49 patients who underwent mastoidectomy for SA. RESULTS The patients ranged in age from 8 months to 21 years. Two patients were re operated on the same side due to recurrent abscess. Forty-five percent of the patients were treated using antibiotics at home and 58.8% of patients had no history of middle ear infection prior to admission. CT underestimated abscess in two patients who were operated on based on their clinical signs. Perisinus abscess was drained during mastoidectomy in one child. Purulent discharge was obtained from the abscess in 41 cases. The most common isolated pathogens were Streptococcus pyogenes and Staphylococcus aureus. Cholesteatoma was found during mastoidectomy in six patients (11.3%). Twenty-four patients (49%) developed postoperative sequela including various middle ear infections, mastoiditis, recurrent SA and impaired hearing. CONCLUSIONS Mastoid SA is a unilateral mainly children's disease that can recur. Cholesteatoma can associate the abscess and could be found in older children and recurrent abscess. High morbidity rate requires long-term follow-up for these patients.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, 52621 Tel Hashomer, Israel.
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Talmi YP, Yakirevitch A, Migirov L, Horowitz Z, Bedrin L, Simon Z, Pfeffer MR. Limited Use of Complementary and Alternative Medicine in Israeli Head and Neck Cancer Patients. Laryngoscope 2005; 115:1505-8. [PMID: 16094133 DOI: 10.1097/01.mlg.0000172205.31559.8d] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS/OBJECTIVE The use of complementary or alternative medicine (CAM) is growing among cancer patients. A Medline search failed to reveal any dedicated report of CAM use specifically in patients with head and neck cancer (HNC). STUDY DESIGN Use of CAM was evaluated in a cohort of treated HNC patients. METHODS Patients treated for HNC were asked if they had used CAM since their diagnosis. Demographic data and data pertaining to mode of CAM, duration of treatment and effects were obtained. RESULTS One hundred forty-three patients (mean age 61 years) were included. Only nine patients (6.3%) reported using disease related CAM. This included acupuncture (4), Reiki (2), naturopathy (2), hypnosis (1), shiatsu (1), chiropractic treatment (1), homeopathy (1), and selenium (1). CONCLUSION Contrary to the reported use, few of our HNC patients used CAM. Although this could be related to good caregiver-patient relationship, further studies in comparable populations are warranted to evaluate if this is a local or a pervading finding in head and neck cancer patients.
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Affiliation(s)
- Yoav P Talmi
- Departments of Otorhinolaryngology-Head and Neck Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Abstract
A prospective analysis of olfaction was performed in 21 patients receiving cisplatin. A reduction in olfactory function was noted in only one patient. Hearing impairment was documented in nine patients, none of whom had impaired sense of smell. We conclude that cisplatin has no major deleterious effect on olfactory function at doses which cause hearing impairment.
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Affiliation(s)
- A Yakirevitch
- Department of Otolaryngology-Head and Neck Surgery, The Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - Y P Talmi
- Department of Otolaryngology-Head and Neck Surgery, The Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
- Tel Aviv University, Sackler School of Medicine, Israel
| | - Y Baram
- Oncology Institute, The Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - R Weitzen
- Oncology Institute, The Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - M R Pfeffer
- Oncology Institute, The Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
- Tel Aviv University, Sackler School of Medicine, Israel
- Oncology Institute, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. E-mail:
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