Search

Objective: The purpose of this study is to characterize Medicare reimbursement trends for laryngology procedures over the last two decades. Methods: This analysis used CMS' Physician Fee Schedule (PFS) Look‐Up Tool to determine the reimbursement rate of 48 common laryngology procedures, which were divided into four groups based on their practice setting and clinical use: office‐based, airway, voice disorders, and dysphagia. The PFS reports the physician service reimbursement for "facilities" and global reimbursement for "non‐facilities". The annual reimbursement rate for each procedure was averaged across all localities and adjusted for inflation. The compound annual growth rate (CAGR) of each procedure's reimbursement was determined, and a weighted average of the CAGR for each group of procedures was calculated using each procedure's 2020 Medicare Part B utilization. Results: Reimbursement for laryngology procedure (CPT) codes has declined over the last two decades. In facilities, the weighted average CAGR for office‐based procedures was −2.0%, for airway procedures was −2.2%, for voice disorders procedures was −1.4%, and for dysphagia procedures was −1.7%. In non‐facilities, the weighted average CAGR for office‐based procedures was −0.9%. The procedures in the other procedure groups did not have a corresponding non‐facility reimbursement rate. Conclusion: Like other otolaryngology subspecialties, inflation‐adjusted reimbursements for common laryngology procedures have decreased substantially over the past two decades. Because of the large number of physician participants and patient enrollees in the Medicare programs, increased awareness and further research into the implications of these trends on patient care is necessary to ensure quality in the delivery of laryngology care. Level of Evidence: NA Laryngoscope, 134:247–256, 2024 [ABSTRACT FROM AUTHOR]

Aims: The LUMINA trial demonstrated a very low local recurrence rate in women ≥55 years with low‐risk luminal A breast cancer (defined as grade I‐II, T1N0, hormone receptor positive, HER2 negative and Ki67 index ≤13.25%) treated with breast‐conserving surgery and endocrine therapy (but no other systemic therapy), supporting the safe omission of radiation in these women. Here we describe the protocol for Ki67 assessment, the companion diagnostic used to guide omission of adjuvant radiotherapy. Methods: Ki67 immunohistochemistry was performed on full‐face sections at one of three regional labs. Pathologists trained in the International Ki67 in Breast Cancer Working Group (IKWG) method demarcated tumour areas on scanned slides and scored 100 nuclei from each of at least five randomly selected 1‐mm fields. For cases with high Ki67 heterogeneity, further virtual cores were selected and scored in order to confidently assign a case as luminal A (≤13.25%) or B (>13.25%). Interlaboratory variability was assessed through an annual quality assurance programme during the study period. Results: From the quality assurance programme, the mean Ki67 index across all cases/labs was 13%. The observed intraclass correlation coefficient (ICC) and kappa statistics were ≥0.9 and ≥0.7, respectively, indicating a substantial level of agreement. Median scoring time was 4 min per case. The IKWG‐recommended scoring method, performed directly from slides, requiring up to four scored fields, is concordant with the LUMINA scoring method (ICC ≥ 0.9). Conclusion: Ki67 is a practical, reproducible, and inexpensive biomarker that can identify low‐risk luminal A breast cancers as potential candidates for radiation de‐escalation. Clinical trial registration: ClinicalTrials.gov number, NCT01791829 [ABSTRACT FROM AUTHOR]

Understanding how event‐related potentials (ERPs) change following repeated assessments is critical to advance our understanding of neural mechanisms implicated in psychopathology. Specifically, it is unclear if associations between ERPs and individual differences can be reproduced when repeatedly measured within the same participants, or if clinical characteristics impact ERP trajectories over repeated assessments. The present study assessed P300 amplitude and latency from a flanker task at four time points over one month (M = 7.24 days between assessments [SD = 1.02]) in 79 female undergraduates to examine how P300 amplitude/latency changes across repeated assessments, the presence of associations between within‐ and between‐subjects measures of current depressive symptoms and the P300, and if between‐subjects depressive symptoms moderated change in P300 over repeated assessment. Results using multilevel modeling indicated a significant reduction in P300 amplitude and latency across assessments. Individuals with increased trait anhedonia (i.e., between‐subjects) exhibited reduced P300 amplitudes across assessments; there were no associations of within‐subjects fluctuations in anhedonia symptoms and P300 amplitude across assessments. There was also no interaction between number of assessments and between‐subjects anhedonia in relation to P300 amplitude. Unlike anhedonia, between‐subjects dysphoria was unrelated to P300. These results demonstrate a relatively specific and consistent association between an attenuated P300 amplitude and trait anhedonia across repeated assessments – data that may further suggest that flanker P300 amplitude reflects hedonic and motivational processes. It is unclear if associations between ERPs and individual differences can be reproduced when repeatedly measured within the same participants, or if clinical characteristics impact ERP trajectories. In the present study, flanker P300 amplitude and latency both decreased with repeated assessments. Furthermore, only reduced flanker P300 amplitude were related to increased trait anhedonia at all four assessments demonstrating a reproducible association between flanker P300 and individual differences in hedonic processing. [ABSTRACT FROM AUTHOR]

Our objective was to examine the prevalence and predictors of delayed medical care due to transportation barriers among children with atopic dermatitis (AD) living in the United States (US). We analyzed data from the 1998–2018 National Health Interview Survey, a nationally representative survey of US households. In 2018, transport‐delayed care was reported for 3.4% of US children with AD, representing approximately 279,000 children annually given the National Health Interview Survey's weighted survey design, and was more common among patients of lower socioeconomic status. Targeted interventions aimed at reducing transportation barriers to healthcare among at‐risk AD patients may reduce health disparities related to AD. [ABSTRACT FROM AUTHOR]

To filter specifically for clinically-active self-identified dermatologists, we utilized the search terms "dermatologist" (encapsulating pediatric and cosmetic dermatologists), "dermatopathologist", "dermatologic surgeon", and "Mohs surgeon." We extracted publicly available campaign contribution data from the Federal Election Commission (FEC) website from 2003 (first year for which data are available) through 2020.[5] Individual contributions are indexed with information including contributor name, occupation, state, donation date/amount, and political candidate or PAC to which the donation was made. We manually reviewed each contribution line to exclude non-clinically-active dermatologists (e.g. "retired dermatologist") and incorrect entries (e.g. contributions with negative monetary value, likely due to database error). [Extracted from the article]

Objective: Placenta accreta spectrum (PAS) is associated with significant maternal morbidity mainly related to blood loss. Pre-operative planning is aided by antenatal ultrasound and magnetic resonance imaging. We sought to assess whether three-dimensional (3D) models from MR images were accurate when compared with surgical and pathological findings. Methods: Digital Imaging and Communications in Medicine files containing MR images with varying severity of PAS (n = 4) were modeled using 3D Slicer. Placenta, bladder, and myometrial defects were modeled. Myometrial defects at three different uterine locations were included—anterior, lateral and inferior. 3D models were used to identify the relationship between the myometrial defect and the internal cervical os. Findings were validated in a larger series of PAS cases (n = 14) where patterns of invasion were compared with estimated blood loss and distance from defect to the internal os. Results: The defect illustrated in the four 3D models correlates to both surgical and pathological findings in terms of depth and pattern of invasion, location of defect, bladder involvement. Blood loss and topography of the defect from 3D modeling were examined in 14 further cases. Inferior defects were associated with increased blood loss compared with anterior defects. Increased distance from cervix was associated with reduced blood loss (R² = 0.352, P = 0.01). Conclusion: Three-dimensional models of PAS provide an accurate preoperative description of placental invasion and should be investigated as a tool for selecting patients for uterine-conserving surgery. Accurate 3D models of placenta accreta spectrum are achievable and may provide additional information, such as distance of the defect from the internal os. [ABSTRACT FROM AUTHOR]

Shortly after losing her health insurance in 2018, Jane Robinson died of a treatable respiratory infection. This article argues that Jane's death occurred at the nexus of two different approaches to care: the necropolitics of uncare and the micropolitics of generative care labor. Both of these approaches to care increased Jane's health and social vulnerability, in turn quickening her death. We adopt the necropolitics of uncare framework to identify and name the harmful policies and attitudes of disregard that control access to life saving medical care. In the micropolitics of care in Jane's life, she became the safety net for others, which left little over when her health began to deteriorate. This social autopsy reveals that her care networks were insufficient to undo the uncare enshrined in state policy. Jane's unnecessary death foreshadowed the excess mortality that the United States has experienced from COVID‐19. [ABSTRACT FROM AUTHOR]

Dear Editor, Costa Rica is the only Central American country with a higher life expectancy than the U.S.A.1 However, few studies characterize the country's skin cancer burden. Across provinces, there was a positive correlation between proportion of White/Mestizo individuals and skin cancer incidence ( I r i = 0.40, I r i SP 2 sp = 0.16) and a negative correlation between proportion of Afro-descendant individuals and skin cancer incidence ( I r i = -0.24, I r i SP 2 sp = 0.05). [Extracted from the article]

Introduction: The American Society for Dermatologic Surgery (ASDS) established a cosmetic dermatologic surgery fellowship in 2013. Programs often outline details of fellowships on their websites to help prospective applicants make informed decisions. Our primary goal was to evaluate the content quality of online information for all ASDS‐accredited cosmetic dermatologic surgery fellowships on program websites and the ASDS website. Our secondary goal was to describe program activity on social media platforms as another avenue for applicant recruitment. Methods: Program websites were assessed using an aggregate score from twenty‐one standardized content quality variables. Social media activity on Facebook and Instagram from January 6 2021, to March 6, 2021, was categorized. Results: Among 24 cosmetic dermatologic surgery fellowship programs, 23 had websites. Basic information was provided across most websites or the ASDS website (eg, address, 95.8%), but more qualitative variables like research opportunities or didactic schedule were not consistently reported. Most programs had highly active social media accounts (91.7% on Facebook and 79.2% on Instagram). Conclusion: There is a gap of information availability between the ASDS website and individual cosmetic dermatologic surgery fellowship websites. Increasing information availability may enhance the applicant recruitment process and serve as a low‐cost intervention to ensure optimal fit. [ABSTRACT FROM AUTHOR]

The article focuses on the major benefit of the Affordable Care Act of expanding Medicaid to low-income adults in the U.S. Topics discussed include the importance of taking a public stand in favor of preserving the positive aspects of the law, the role and limitations of a public anthropology in larger health-care debates through unsuccessful attempts to publicize ethnographic research in health-policy and clinical journals and arguments about the importance of Medicaid expansion.

Dear Editor, We enjoyed reading Costello et al.'s publication regarding the role of research years in a successful dermatology residency match.1 In their study, the authors found no difference overall in match rates between research year versus non-research year applicants, although research year applicants more often matched into top residency programs. For one, pre-residency dermatology publications may predict the pursuit of an academic dermatology career after residency.1 Adopting a broader view of what constitutes a "strong" dermatology application beyond traditional research productivity metrics (e.g., number of publications) may improve retention of academic dermatologists and augment changes to reduce inequity in the match process. [Extracted from the article]

The RET receptor tyrosine kinase ( RTK) contributes to kidney and nervous system development, and is implicated in a number of human cancers. RET is expressed as two protein isoforms, RET9 and RET51, with distinct interactions and signaling properties that contribute to these processes. RET isoforms are internalized from the cell surface into endosomal compartments in response to glial cell line-derived neurotropic factor ( GDNF) ligand stimulation but the specific mechanisms of RET trafficking remain to be elucidated. Here, we used total internal reflection fluorescence ( TIRF) microscopy to demonstrate that RET internalization occurs primarily through clathrin coated pits ( CCPs). Activated RET receptors colocalize with clathrin, but not caveolin. The RET51 isoform is rapidly and robustly recruited to CCPs upon GDNF stimulation, while RET9 recruitment occurs more slowly and is less pronounced. We showed that the clathrin-associated adaptor protein complex 2 ( AP2) interacts directly with each RET isoform through its AP2 μ subunit, and is important for RET internalization. Our data establish that interactions with the AP2 complex promote RET receptor internalization via clathrin-mediated endocytosis but that RET9 and RET51 have distinct internalization kinetics that may contribute to differences in their biological functions. [ABSTRACT FROM AUTHOR]

Objective: Macrophages are major producers of inflammatory cytokines; however, their role in chronic rhinosinusitis (CRS) has not been clearly defined. The aim of this study was to quantify macrophages in sinus tissue of patients with various subtypes of CRS and determine the impact of atopic status on macrophage infiltrate.Study Design: Prospective immunohistochemical study of human sinonasal tissue.Setting: Academic medical center.Subjects and Methods: Human sinonasal tissue was taken from patients with CRS with nasal polyposis (CRSwNP, n = 8), CRS without nasal polyposis (CRSsNP, n = 8), and controls (n = 8) undergoing surgery for CSF leak repair or endoscopic excision of non-secreting pituitary tumor. Samples were immunohistochemically stained for macrophage/monocyte markers Mac387 and CD68.Results: CRSwNP patients had significantly increased numbers of Mac387 and CD68 cells compared to control patients (P < .05) or CRSsNP patients (P < .01). CRSsNP had significantly increased number of cells staining for CD68 compared to controls (P < .05). The increased presence of macrophages measured by either marker in CRSwNP was independent of atopic status.Conclusion: Macrophages are increased in CSRwNP patients regardless of atopic status and may contribute to the immunopathology of CRS. [ABSTRACT FROM AUTHOR]

The article offers information on the study which identifies the frequency and relationship between chronic otitis media and dynamic ciliary beat in children that undergone adenoidectomy. It mentions the use of isoproterenol or methacholine to stimulate the cilia-bearing tissue. It states that after two and three hours of application of isoproterenol results to dynamic ciliary beat frequency which is a ciliary dysfunction.

The article focuses on a study conducted to analyze the role of Vitamin D3 deficiency in the increment of dendritic cells in mucosa. It informs that randomized controlled trial was conducted on the samples collected from pediatric patients. According to the results, children with allergic fungal rhinosinusitis (AFRS) or chronic rhinosinusitis with nasal polyposis (CRSwNP) were Vitamin D3 deficient and may be linked with increase number of dendritic cells.

Objective. Environmental tobacco smoke exposure in children increases the incidence of upper respiratory infections, chronic sinusitis, and chronic otitis media. This study investigated the effects of ex vivo and in vitro smoke exposure on dynamic ciliary beat frequency (CBF) in pediatric adenoid explants.Study Design. Blinded and controlled prospective study.Setting. Tertiary care pediatric hospital.Subjects and Methods. Fifty-five children undergoing adenoidectomy for obstructive sleep apnea and adenotonsillar hypertrophy were enrolled in this study. Adenoids were surgically removed using currettage. Hair was collected for nicotine analysis. Tissue was sectioned into 1-mm strips and allowed to equilibrate in DMEM/F12 with 2% fetal bovine serum for 24 hours. Cilia-bearing explant tissues were treated with either DMEM/F12 media, 5% cigarette smoke extract (CSE), or 10% CSE for 24 hours. Cilia were then stimulated using either isoproterenol (10−9 M) or methacholine (10−6M), and CBF was serially recorded using the Sisson-Ammons Video Analysis (SAVA) software.Results. Children with hair nicotine levels ≥1 ng/mg consistent with secondhand smoke exposure display blunted dynamic CBF response ex vivo. Explants incubated with CSE in vitro demonstrate significant impairment of isoproterenol and methacholine-induced CBF.Conclusion. CBF of adenoid explants increases when stimulated with isoproterenol and methacholine. Ex vivo and in vitro smoke exposure blunted ciliostimulation of CBF in adenoid explants. Smoke exposure impairs ciliary function in the pediatric airway and could potentially contribute to disorders such as chronic rhinosinusitis and chronic otitis media. [ABSTRACT FROM PUBLISHER]

Various types of cotton and polyester fabrics were tested to ascertain the optimal physical and chemical characteristics of fabrics needed for the removal of cellular material from surfaces. DNA quantitation values obtained on dried saliva stains showed no difference between cotton and polyester across all constructions and solvent conditions. Fabrics used dry and with water yielded higher quantitation values than those used with isopropanol. Quantitation values were also higher for wovens and nonwovens than knits across all solvent conditions. Low thread count fabrics used with water yielded higher quantitation values, but no correlation between thread count and quantitation values was observed with dry fabrics. A low thread count woven fabric, however, outperformed other tested fabrics when swabbing object surfaces in a highly used room. Full DNA profiles from fingerprints on glass surfaces were obtained with low thread count woven and nonwoven fabrics but not with the knit fabric tested. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Exposure to cigarette smoke is a risk factor for chronic rhinosinusitis. Current literature confirms complement fragments are activated in human nasal mucosa. The mechanism(s) responsible for this activation is unclear. We investigated the effects of cigarette smoke on nasal mucosa in vitro and via a model of cigarette smoke exposure by using animals deficient in complement components. Study Design: Prospective, controlled animal and in vitro human cell line study. Setting: University laboratory. Subjects and Methods: Human respiratory epithelial cells were exposed to five, 10, and 20 percent cigarette smoke extract (CSE) in vitro in the presence or absence of human serum. Complement activation was assessed by enzyme-linked immunosorbent assay and immunofluorescent techniques. Complement-deficient (C3–/–, n = 6; factor B–/–, n = 50) and sufficient mice (wild type, n = 10) were exposed to the smoke of four cigarettes per exposure for two exposures per day for three days. Mice were sacrificed 12 hours after the last exposure, and the nasal cavity was surgically removed. Histological characteristics were analyzed by the use of a subjective scale and quantitative image analysis scoring systems. Results: In vitro analysis of respiratory cell cultures demonstrated that exposure of serum to CSE resulted in complement activation. Furthermore, immunofluorescent staining for C3d could only be demonstrated in CSE-exposed cultures. In vivo analysis demonstrated that complement deficiency, either C3 or factor B deficiency, resulted in a significant reduction in histological evidence of damage as compared with wild-type control mice (wild type vs C3–/–, P = 0.02; wild type vs factor B–/–, P = 0.07; no significant difference between C3–/– vs factor B–/–). Conclusion: These data demonstrate that cigarette smoke activates the complement system. Furthermore, complement deficiency protected against smoke-induced mucosal damage in this small series. [Copyright &y& Elsevier]

Abstract: Objective: Local production of antigen-specific IgE in allergic fungal rhinosinusitis (AFRS) is likely integral to the expression of allergy. This study examines if there are anatomic variations in local IgE expression or if variations among fungal and nonfungal IgE exist. Study Design: Cross-sectional study. Setting: Tertiary medical center. Subjects and Methods: Specimens from 11 AFRS, 8 chronic rhinosinusitis without nasal polyps (CRSsNP), and 9 control patients underwent immunohistochemical localization for IgE and evaluation for antigen-specific IgE by ImmunoCAP testing. Results: Inferior turbinate (IT) epithelium had greater IgE staining in AFRS than control (P = 0.013) and CRSsNP (P = 0.002). A significant difference was also found at the IT subepithelial level for AFRS compared with controls (P = 0.001) and CRSsNP (P < 0.001). Within AFRS, IgE staining was increased in the subepithelium compared to epithelium (P = 0.003). ImmunoCAP analysis on IT tissue from AFRS and controls demonstrated increased antigen-specific IgE for 5 of 14 antigens (P < 0.05) and total IgE (P < 0.001). There were no significant anatomic differences between IT and sinus IgE staining. Conclusion: More fungal and nonfungal IgE is expressed in IT and sinus tissues of AFRS patients, as compared with control and CRSsNP patients. [Copyright &y& Elsevier]

Multiple endocrine neoplasia Type 2 (MEN 2) is an inherited cancer syndrome characterized by medullary thyroid carcinoma (MTC). The disease has three subtypes, which are distinguished by the presence of additional phenotypes. In particular, pheochromocytoma occurs in approximately 50% of patients with the MEN 2A or MEN 2B subtypes, but is not found in patients with the milder disease subtype, familial MTC (FMTC). All subtypes of MEN 2 are caused by activating mutations of the RET (REarranged in Transfection) proto-oncogene. RET encodes a transmembrane receptor tyrosine kinase, required for development of neuroendocrine cell types and the kidneys. All MEN 2 subtypes are associated with single amino acid substitution mutations that are found in either the extracellular domain or in the kinase domain of RET. There are strong genotype–phenotype correlations in MEN 2 between patient phenotype and the specific residue that is mutated. MEN 2A is primarily associated with substitutions at five extracellular cysteine residues, while 95% of MEN 2B is associated with a single methionine to threonine mutation in the kinase domain (M918T). In FMTC, RET mutations are more broadly distributed, with both extracellular cysteines and intracellular sites implicated. In all cases, MEN 2-RET mutations result in constitutive activation of the receptor, although the mechanism and relative functional effects of the mutations vary. Recent advances in functional characterization and development of molecular models of RET and of various MEN 2-RET mutants are helping us understand tissue-specific differences in oncogenic potential conferred by the different RET mutations. Here, we discuss and compare several well-characterized mutations of the extracellular and kinase domains, which have quite varied functional implications. [ABSTRACT FROM AUTHOR]

This article examines how much fathers participate in child care, an important component of domestic duties, and factors related to it. It has the advantage of longitudinal data, so that it is possible to look at changes in fathers' participation and factors affecting changes and continuities over time. The data come from the 1987-1988 and 1992-1993 National Surveys of Families and Households. The sample is restricted to White, two-parent families with at least one child younger than 5 years of age at the time of the first survey. The analyses control for the number of children and the gender of the child for whom there is fathering information. Based on prior theories and research, the study variables related to fathers' child care include performance of household tasks, their marital quality, gender role ideologies, perceptions of the fairness of the division of domestic labor, and the mothers' childcare hours. The labor-force variables are the husbands' and wives' hours of paid employment, as well as the earned incomes of husbands and wives. The findings indicate that hours on the job keep some men from active fathering, but if they begin taking care of young children, a continuing pattern is established. Mothers' child-care hours are positively related to fathers' child care, and fathers do more with sons. The discussion places the findings in theoretical context. [ABSTRACT FROM AUTHOR]

The late positive potential (LPP) is characterized by temporal and spatial changes across development—though existing work has primarily relied on visual or statistical comparisons of relatively few electrodes and averaged activity over time. The current study used an empirically based approach to characterize temporal and spatial changes in ERPs over time. Data were utilized from a large longitudinal study (N = 380) in which the LPP was recorded to pleasant, neutral, and unpleasant pictures around age 9 and again around age 12. Age 9 ERPs were subtracted from age 12 ERPs for all three image types; the resulting ERPs for each subject at each electrode site were then submitted to a temporospatial principal component analysis (PCA). A PCA factor was greater in amplitude for emotional pictures compared to neutral pictures between ages 9 and 12, evident as an occipital negativity and frontocentral positivity that peaked approximately 850 ms following picture presentation. Furthermore, the factor scores to emotional pictures for this component increased as a function of age 12 pubertal development, consistent with the notion that the LPP shifts from occipital to more frontocentral sites in relation to developmental changes from childhood to adolescence. A similar factor was observed when PCA was applied to all ERPs from both ages 9 and 12. Using temporospatial PCA on ERPs collected from the same subjects over time—especially within‐subject subtraction‐based ERPs—provides a concise way of characterizing and quantifying within‐subject developmental changes in both the timing and scalp distribution of ERPs. This work presents an empirically based approach to characterizing developmental changes in ERPs by performing temporospatial PCA on ERPs from two within‐subject assessments. This method provides a holistic metric representing a linear combination of all time points and electrode sites and may be more sensitive to developmental changes in ERPs. Finally, the present study extends previous developmental studies of the LPP by demonstrating that developmental shifts in the LPP to emotional images are correlated with pubertal development, suggesting that these changes in emotional processing occur as a function of typical development in adolescence. [ABSTRACT FROM AUTHOR]

The menstrual cycle impacts mood and neural response to reward—phenomena that may be related to natural fluctuations in ovarian hormones. Using a within‐subject design, the present study examined ovarian hormones (i.e., estradiol and progesterone) and ERPs in response to feedback indicating gains and losses in both the follicular and luteal phases of the menstrual cycle. We examined whether hormone levels and variation in neural response to reward and loss across menstrual cycle phases were associated with depressive symptoms. Participants high in depressive symptoms showed a reduced reward positivity (RewP) to monetary gains during the luteal phase of the menstrual cycle as compared to the follicular phase, while those low in depressive symptoms showed no change in the RewP to monetary gains between phases. Thus, increased fluctuation in the neural response to gains (but not losses) across menstrual cycle phases was associated with greater depression symptoms. Overall, findings indicate that hormonal fluctuations associated with the menstrual cycle may relate to depressive symptoms by altering reward sensitivity. Furthermore, fluctuation in the neural response to rewards over the menstrual cycle may play an important role in the expression of depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective: Macrophages are major producers of inflammatory cytokines; however, their role in chronic rhinosinusitis (CRS) has not been clearly defined. The aim of this study was to quantify monocytes and macrophages in sinonasal tissue of patients with various subtypes of CRS. Method: Human sinonasal tissue was taken from patients with CRS with nasal polyposis (CRSwNP), CRS without nasal polyposis (CRSsNP), and allergic fungal rhinosinusitis (AFRS). Control tissue was taken from patients without evidence of inflammatory sinus disease. Samples were immunhisotychemically stained for macrophage/monocyte markers Mac387, CD68, and PM‐2K. Results: AFRS patients had approximately 4 times as many Mac387 and CD68 staining cells as CRSsNP and control patients (P <. 05). CRSwNP patients had approximately 2.5 times as many Mac387 cells and 3 times as many CD68 cells as CRSsNP and control patients (P <. 05). There were trends toward increased numbers of cells staining positively for PM‐2K in tissue samples of AFRS and CRSwNP, and increased staining of CD68 and PM‐2K in atopic CRWwNP patients; however, this did not reach statistical significance. Conclusion: Macrophages are increased in CSRwNP and AFRS patients and may contribute to the immunopathology of CRS. [ABSTRACT FROM AUTHOR]

Introduction Fine needle aspiration (FNA) is a well-established diagnostic technique which is frequently used to diagnose head and neck neoplasms. Clinical decisions concerning treatment of malignant salivary gland tumours, the extent of surgery and advisability of pre-operative irradiation can be helped by prior knowledge of tumour type. Aim The aim of this study was to do an audit of all salivary gland FNAs carried out in Beaumont Hospital over a 14-year period. Methods All salivary gland FNAs between 1989 and 2002 were reviewed. Where available, the corresponding follow-up histological specimens were studied. Results During this 14-year period, 305 patients with salivary gland lesions had FNA of the lesion performed. The total number of aspirates performed was 343. Of these, 184 had histologies available for follow-up. Eighty-nine aspirates were reported as inadequate; 89 as inflammatory, normal or consistent with cyst contents. One hundred and thirteen aspirates were diagnosed as a benign entity. Thirty-three aspirates were reported as malignant (21 of which were felt to be primary to the salivary gland and 12 metastatic). Sixteen cases were called suspicious. Good correlation between FNA findings and histology was seen in the majority of cases (145 of 183). Some diagnostic problem areas were identified. These included the following: lymphomas (seven called benign on FNA), Warthin's tumour (seven not diagnosed or misdiagnosed on FNA) and mucoepidermoid carcinoma (one reported as pleomorhic adenoma and one as benign/cystic on FNA). Seven pleomorphic adenomas were not diagnosed on FNA pre-operatively, predominantly due to inadequacy of the specimen. Three other malignancies (acinic cell carcinoma, lymphoepithelial carcinoma and carcinoma ex-pleomorphic adenoma), while not diagnosed on FNA, were called suspicious, with re-biopsy advised. Conclusion FNA cytology of salivary glands is an accurate method for evaluation of both benign and malignant lesions, enabling optimum surgical and adjuvant therapy decision-making pre-operatively. Well-defined problem areas are identified and, therefore, clinicopathological correlation is required in these cases. [ABSTRACT FROM AUTHOR]