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Type III frontal sinusotomy: surgical technique, indications, outcomes, a multi-university retrospective study of 120 cases. Draf type III is one of the advanced endonasal endoscopic surgeries for the frontal sinus. It was popularised by W. Draf in 1991. The procedure - which is also known as the modified endoscopic Lothrop procedure - aims to create the largest possible anteroposterior and lateral to lateral opening between both frontal sinuses and the nasal cavities. This requires the resection of the medial floor of both frontal sinuses, the intersinus septum and the superior nasal septum. The authors present a retrospective study including a cohort of 120 patients who underwent surgery in six Belgian university ENT departments. Mean follow-up was 24.6 months (range: 5-36 months). This paper describes the surgical procedure and reviews the indications, comorbidities, outcomes and complications of the type III frontal sinusotomy. Some correlations are also established with the data published in the worldwide literature. The authors conclude that the Draf III is a demanding procedure requiring considerable expertise in endoscopic sinus surgery. The procedure is effective with a success rate of 87.5%. Indeed, 12.5% of patients only experienced closure of the neoostium while 20% of all the patients had unchanged or worse symptomatology. The percentage of post-operative complications is 7.5%. All complications were managed successfully

This study is intended to demonstrate the versatility and feasibility of custom-made oligosaccharide- exposing neoglycoconjugates including histo-blood group epitopes in various human lesions, including nasal polyps. The binding of the biotinylated probes was determined on formalin-fixed paraffinembedded sections from archive materials. The general aspects of our results may be interpreted as follows: the neoglycoconjugates used here can readily detect differences in the ability of cells to bind glycan residues in tissue sections, thereby enabling the extent of the binding capacity of various types of human lesions to be compared. Furthermore, the reactivity to glycan may reflect characteristics of the cells and their environment. The investigation into pathological disorders with respect to the binding capacity of these carrierimmobilized mono- or oligosaccharide structures derived from custom-made synthesis or biochemical purification is based on the prospect of translating progress in this field into the establishment of potentially beneficial procedures for medical diagnosis and pathological classification.

Radiosurgery is an alternative to the microsurgical resection of vestibular schwannoma (VS). Since its introduction, radiosurgery has been used in more than 8000 patients with VS worldwide and the long term tumor control rates are reported to be 86 to 100%. The aim of this study is to report our experience with Leksell Gamma Knife (LGK) radiosurgery in the management of VS and to evaluate the serviceable hearing preservation rate after one-year follow-up.Between January 2000 and October 2002, 95 patients with unilateral VS underwent LGK radiosurgery at the University Erasmus Hospital of Brussels with the first worldwide installed LGK C. All patients in our series underwent evaluation with high resolution neurodiagnostic imaging including computed tomography and MRI, and clinical evaluation as well as audiological tests that included tonal and vocal audiometries. The Gardner Robertson (GR) classification is used to report the results of this study. We identified 48 patients treated for VS with LGK, tested and retested with vocal and tonal audiometries by the same team, and followed for a minimum of one year. There were 38 patients with previously untreated VS (9 grade I, 9 grade II, 20 grade III according to Koos) and 10 patients with postoperative evolutive residual tumor.Before LGK, 24 patients had serviceable (17 GR class I and 7 GR class II) hearing; 16 (67%) of these patients had preservation of serviceable hearing (Pure tone average50 db and Speech discrimination50%) at the one-year audiological follow-up. It was observed that 9 of the 17 GR class I patients (52.9%) maintained their level of audition and 14 of these (82.3%) preserved serviceable hearing. No deterioration of hearing occurred in the 7 patients with preradiosurgery radiosurgery nonserviceable hearing (GR class III) at the one-year follow-up. One patient improved from GR class V to III after LGK. No patient developed trigeminal neuropathy and only one patient who had preradiosurgery facial nerve dysfunction experienced deterioration at one-year follow-up.In view of the high tumor control rate and excellent long-term cranial nerve preservation rates, LGK radiosurgery should now be considered as an excellent alternative strategy to microsurgery for the management of VS grade I to III as well as in cases of residual tumor after microsurgery. Compared to results obtained in centers with long-term experience, our data suggest that LGK radiosurgery is an efficient reproducible therapeutic approach that offers high rate of hearing preservation. This justifies the choice of radiosurgery as the first treatment option in VS.

Nasal polyposis is a model for the study of inflammatory processes. We analyzed the expression of galectin-7, a growth regulator, in surface epithelium, glandular epithelium, and connective tissue in human nasal polyps, and examined the effect of the glucocorticoid budesonide on its expression in human nasal polyps ex vivo.Using quantitative, computer-assisted microscopy and immunohistochemistry, we measured galectin-7 expression in nine nasal polyps obtained by surgical resection. Five polyps came from allergic patients and four came from non-allergic patients.Galectin-7 was expressed in all three polyp tissues analyzed. Treatment of polyps from allergic and non-allergic patients with 50 ng/ml budesonide increased the extent of galectin-7 expression in the connective tissue (p = 0.01). Conversely, budesonide at this concentration did not apparently affect galectin-7 expression in glandular epithelium; only a slight decrease in the percentage of the galectin-7-immunopositive cells was observed. In the surface epithelium of nasal polyps from non-allergic patients, the percentage of galectin-7-immunopositive cells was decreased (p = 0.03) by treatment with 250 ng/ml budesonide. In nasal polyps from allergic patients, this percentage was increased by treatment with 50 ng/ml budesonide (p = 0.0001).These data are consistent with a role for galectin-7 in the regulation of cell growth through a pro-apoptotic effect. Galectin-7 expression coincides with the degree of epithelial stratification, and is subject to upregulation in the connective tissue in response to treatment with 50 ng/ml budesonide. Budesonide modulates galectin-7 expression differently in the surface epithelia of polyps from allergic and non-allergic patients.