- Email: [email protected]
Hyaluronic acid for the correction of HIV-associated facial lipodystrophy
P80
Otolaryngology– Head and Neck Surgery August 2004
Scientific Session—Monday
10:30 AM to 12:00 PM Room JJCC 1A07 •
Scientific Session: General Moderators: Jonathan L. Levine, Davis, MD
MD,
William E.
10:30 AM Combined Open Septorhinoplasty and Functional Endoscopic Sinus Surgery Jonathan Hilder Lee, MD (presenter); David A Sherris, MD; Eric J Moore, MD Rochester MN; Buffalo NY; Rochester MN
Objectives: To compare perioperative and immediate postoperative complication rates of combined open septorhinoplasty and functional endoscopic sinus surgery to complication rates of the 2 procedures performed individually. Methods: A sample of 57 patients treated at an academic referral center who had undergone combined open septorhinoplasty and functional endoscopic sinus surgery was identified. Medical charts were reviewed to identify complications encountered during, or immediately after the combined procedures. These complication rates were compared to the complication rates of the 2 procedures performed alone as quoted in the general medical literature. Results: Patients ranged in age from 14 to 77 years (mean age, 42 years). Among the 57 cases, there were 7 (12%) minor complications and no major complications. Of the minor complications, there were 4 cases of mild cellulitis (7%) and 3 cases of postoperative epistaxis (5%). No other intraoperative or early postoperative complications were found. Conclusions: Open septorhinoplasty and functional endoscopic sinus surgery may be safely and effectively performed in combination without a significantly increased risk of complications when compared to either procedure performed individually. The slightly increased risk of cellulitis encountered in our study may warrant careful consideration of the use of postoperative antibiotic prophylaxis following combined open septorhinoplasty and functional endoscopic sinus surgery. 10:38 AM In Vitro Analysis of Expression of Matrix Molecules and Growth Factors in Chrondrocytes Ulrich Goessler, MD (presenter); Peter Bugert; Karen Bieback; Haneen Sadick, MD; Karl Hoermann, MD; Frank Riedel, MD Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany
Objectives: Tissue engineering represents a promising method for the construction of autologous chondrogenic grafts for reconstructive surgery. As in cultured chondrocytes the dedifferentiation and proliferation of the cells are critical factors that influence the generation of transplants, the aim of our study was to find and characterize markers for these processes. Methods: Human chondrocytes were isolated from septal cartilage (n ⫽ 32) and held in primary cell culture. Cells were harvested after 1, 6, and 21 days. The differentiation of the cells was investigated with bright-field-microscopy, the expression patterns of various proteins using immunohistochemistry, the expression of distinct genes with microarraytechnique. Results: The chondrocytes showed a strong proliferation. After 6 and 21 days, Collagen 9, 10, 18, and Q were downregulated. Collagen 3, 4, 8, and 11 were activated. Collagen 1 and 2 were downregulated after 6 days, but were reactivated after 21 days. TGF beta1 was strongly expressed on day 1, 6, and 21, TGF beta3 and beta4 were upregulated from day 1 to day 21. The TGF beta-receptors I and II were never expressed, the TGF-beta-receptor III was expressed on day 1, 6, and 21. Integrin beta1, beta5, and alpha5 were upregulated from day 1 to day 21, Integrin beta3, and alpha3 were downregulated. Conclusions: Collagen 3, 4, 8, 9, and 11 might be new markers for the dedifferentiation of chondrocytes. TGF beta3 and beta4 might influence the dedifferentiation, which is fortified by the expression of TGF-beta-receptor III. Integrin beta1, beta5, and alpha5 might be involved in signal transmission for the dedifferentiation. 10:46 AM Hyaluronic Acid for the Correction of HIV-Associated Facial Lipodystrophy Yotis Tsaparas, MD (presenter); Andrew Denton, BSC MD Vancouver Canada; Vancouver Canada
Objectives: Facial lipoatrophy is a common sequelae of HIV anti-retroviral therapy for which patients seek options for correction. Many types of injectable agents have been utilized. This study presents our results with the use of Perlane, an injectable form of hyaluronic acid. Methods: This was a prospective observational study in a consecutive series of 15 HIV-positive males whose mean age was 45.5 years. Inclusion criteria were antiretroviral therapy for greater than 3 months with clinically evident facial lipodystrophy. Patients where injected under local anesthesia with 2.1 cc of Perlane per side. Subjective patient measurements
MONDAY
Audience participation will be critical.
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
11:00 AM Outcome of GORE-TEX Implants in Augmentation Rhinoplasty Ashok Vasantrao Rokade, MS FRCS DL (presenter); Keith Hughes Warrington United Kingdom; Doncaster United Kingdom
Objectives: The use of graft material in augmentation rhinoplasty presents many challenges to the surgeon. Autologous grafts are the preferred material and have withstood the test of time. GORE-TEX (V. L. Gore and assoc Inc, Flagstaff, AZ) has been projected as a promising implant for nasal augmentation. The aim of our study was to report the outcome of GORE-TEX implants when used in augmentation of nasal dorsum by a single surgeon with a specialist interest in rhinoplastic surgery. Methods: This is a retrospective review of 20 patients who underwent nasal dorsal augmentation using GORE-TEX implant using external rhinoplasty approach. The results were assessed with full preoperative and postoperative photographic documentation and critical assessment during follow-up examination. Patient satisfaction was noted with respect to aesthetic and functional outcome. Results: Two implants (10%) became infected and were removed. One implant was removed 3 months postoperatively and another one after 13 months. Persistent erythema of the nasal skin and minor displacement of the implant was noted in 1 patient. No resorption of any of the grafts was noted. Patients’ perceptions of the feeling of the implant included as normal (50%), firm (30%), soft (5%) and hard (15%). Conclusions: GORE-TEX has demonstrated outstanding safety profile in areas of general and vascular surgery. Although encouraging intermediate results are reported, there is a need of more studies to determine the long-term success and
morbidity of GORE-TEX in rhinoplasty. Until then it can be used as an alternative to rather than in preference to autografts. 11:08 AM Efficacy of Thyroid Hormone Suppression for Benign Thyroid Nodules: Meta-analysis of RCTs Matthew T Sdano, MD (presenter); David L Steward, MD; Mercedes Falciglia, MD; Jeffrey Welge, PhD Cincinnati OH; Cincinnati OH; Cincinnati OH; Cincinnati OH
Objectives: Determine the efficacy of thyroid hormone suppressive therapy (THST) for benign thyroid nodule volume reduction. Methods: Systematic search using electronic databases (PubMed, Medline, Cochrane Library) through January 2004, paper review, and contacting experts. Only randomized controlled studies of THST vs no treatment or placebo, for reduction of benign thyroid nodule volume, were included. Exclusion criteria were: ⬍6-month treatment and lack of ultrasound volume measurement. Primary outcome was clinically relevant nodule volume reduction (⬎50%), with a random effects model (RevMan4.2). Results: Eight randomized trials were included (509 subjects). Subjects were 75% more likely to experience ⬎50% nodule volume reduction with THST than placebo or no treatment (relative risk ⫽ 1.76; 95%CI ⫽ 1.15–2.71; P ⫽ 0.01). However, 8 subjects must be subjected to the risk of cardiac and skeletal side effects from THST, for one to benefit from therapy (number-needed-to-treat ⫽ 8, risk difference ⫽ 0.13; 95%CI ⫽ 0.04 – 0.21; P ⫽ 0.003). Sensitivity analysis reveals that 8 null studies would have to have been missed to reverse statistical significance (fail-safe N ⫽ 8). Review of the only study with long-term follow-up (5 years) suggests no significant difference in nodule volume reduction between THST and placebo. Further, studies with follow-up after THST withdrawal demonstrate rapid increase in thyroid nodule and goiter volumes. Conclusions: THST appears more likely than placebo or no treatment to significantly reduce benign thyroid nodule volume, but long-term treatment may be less effective and regrowth is likely following cessation of therapy. Given the risks of THST, routine use is not recommended for benign disease. 11:16 AM Manual Audiometry vs Self-Automated Otogram: A Comparison of Testing Outcomes Mark A D’Agostino, MD (presenter); Jivianne Lee, MD Madison CT; Los Angeles CA
Objectives: Conventional manual audiometry continues to be the primary diagnostic testing method for the determination of hearing sensitivity and degree of hearing loss. How-
MONDAY
were compared to physician measurements. Complications were recorded. The end point of the study was a complete resorption of product. Results: Mean follow-up time was 8 months. Only 2 patients (13%) demonstrated significant product resorption by 6 months; 13/15 patients (87%) were very pleased with the results. Physician and patient results correlated well. Mean pain scores with injection were 4.3 on a 10-point scale. Two patients experienced minor erythema or telangiectasia resolving within to 2 months. Conclusions: Correction of facial lipodystophy with injectable Perlane is a technically simple office procedure that was well tolerated by nearly all patients. The results produced a high level of patient satisfaction with only minor side effects and no late complications. The 2 patients with severe lipodystrophy could not be fully corrected with the standard volumes used. Our results support Perlane to be a feasible option for the provisional correction of mild to moderate facial lipoatrophy.
Scientific Session—Monday P81
Otolaryngology– Head and Neck Surgery August 2004
Scientific Session—Monday
10:30 AM to 12:00 PM Room JJCC 1A07 •
Scientific Session: General Moderators: Jonathan L. Levine, Davis, MD
MD,
William E.
10:30 AM Combined Open Septorhinoplasty and Functional Endoscopic Sinus Surgery Jonathan Hilder Lee, MD (presenter); David A Sherris, MD; Eric J Moore, MD Rochester MN; Buffalo NY; Rochester MN
Objectives: To compare perioperative and immediate postoperative complication rates of combined open septorhinoplasty and functional endoscopic sinus surgery to complication rates of the 2 procedures performed individually. Methods: A sample of 57 patients treated at an academic referral center who had undergone combined open septorhinoplasty and functional endoscopic sinus surgery was identified. Medical charts were reviewed to identify complications encountered during, or immediately after the combined procedures. These complication rates were compared to the complication rates of the 2 procedures performed alone as quoted in the general medical literature. Results: Patients ranged in age from 14 to 77 years (mean age, 42 years). Among the 57 cases, there were 7 (12%) minor complications and no major complications. Of the minor complications, there were 4 cases of mild cellulitis (7%) and 3 cases of postoperative epistaxis (5%). No other intraoperative or early postoperative complications were found. Conclusions: Open septorhinoplasty and functional endoscopic sinus surgery may be safely and effectively performed in combination without a significantly increased risk of complications when compared to either procedure performed individually. The slightly increased risk of cellulitis encountered in our study may warrant careful consideration of the use of postoperative antibiotic prophylaxis following combined open septorhinoplasty and functional endoscopic sinus surgery. 10:38 AM In Vitro Analysis of Expression of Matrix Molecules and Growth Factors in Chrondrocytes Ulrich Goessler, MD (presenter); Peter Bugert; Karen Bieback; Haneen Sadick, MD; Karl Hoermann, MD; Frank Riedel, MD Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany
Objectives: Tissue engineering represents a promising method for the construction of autologous chondrogenic grafts for reconstructive surgery. As in cultured chondrocytes the dedifferentiation and proliferation of the cells are critical factors that influence the generation of transplants, the aim of our study was to find and characterize markers for these processes. Methods: Human chondrocytes were isolated from septal cartilage (n ⫽ 32) and held in primary cell culture. Cells were harvested after 1, 6, and 21 days. The differentiation of the cells was investigated with bright-field-microscopy, the expression patterns of various proteins using immunohistochemistry, the expression of distinct genes with microarraytechnique. Results: The chondrocytes showed a strong proliferation. After 6 and 21 days, Collagen 9, 10, 18, and Q were downregulated. Collagen 3, 4, 8, and 11 were activated. Collagen 1 and 2 were downregulated after 6 days, but were reactivated after 21 days. TGF beta1 was strongly expressed on day 1, 6, and 21, TGF beta3 and beta4 were upregulated from day 1 to day 21. The TGF beta-receptors I and II were never expressed, the TGF-beta-receptor III was expressed on day 1, 6, and 21. Integrin beta1, beta5, and alpha5 were upregulated from day 1 to day 21, Integrin beta3, and alpha3 were downregulated. Conclusions: Collagen 3, 4, 8, 9, and 11 might be new markers for the dedifferentiation of chondrocytes. TGF beta3 and beta4 might influence the dedifferentiation, which is fortified by the expression of TGF-beta-receptor III. Integrin beta1, beta5, and alpha5 might be involved in signal transmission for the dedifferentiation. 10:46 AM Hyaluronic Acid for the Correction of HIV-Associated Facial Lipodystrophy Yotis Tsaparas, MD (presenter); Andrew Denton, BSC MD Vancouver Canada; Vancouver Canada
Objectives: Facial lipoatrophy is a common sequelae of HIV anti-retroviral therapy for which patients seek options for correction. Many types of injectable agents have been utilized. This study presents our results with the use of Perlane, an injectable form of hyaluronic acid. Methods: This was a prospective observational study in a consecutive series of 15 HIV-positive males whose mean age was 45.5 years. Inclusion criteria were antiretroviral therapy for greater than 3 months with clinically evident facial lipodystrophy. Patients where injected under local anesthesia with 2.1 cc of Perlane per side. Subjective patient measurements
MONDAY
Audience participation will be critical.
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
11:00 AM Outcome of GORE-TEX Implants in Augmentation Rhinoplasty Ashok Vasantrao Rokade, MS FRCS DL (presenter); Keith Hughes Warrington United Kingdom; Doncaster United Kingdom
Objectives: The use of graft material in augmentation rhinoplasty presents many challenges to the surgeon. Autologous grafts are the preferred material and have withstood the test of time. GORE-TEX (V. L. Gore and assoc Inc, Flagstaff, AZ) has been projected as a promising implant for nasal augmentation. The aim of our study was to report the outcome of GORE-TEX implants when used in augmentation of nasal dorsum by a single surgeon with a specialist interest in rhinoplastic surgery. Methods: This is a retrospective review of 20 patients who underwent nasal dorsal augmentation using GORE-TEX implant using external rhinoplasty approach. The results were assessed with full preoperative and postoperative photographic documentation and critical assessment during follow-up examination. Patient satisfaction was noted with respect to aesthetic and functional outcome. Results: Two implants (10%) became infected and were removed. One implant was removed 3 months postoperatively and another one after 13 months. Persistent erythema of the nasal skin and minor displacement of the implant was noted in 1 patient. No resorption of any of the grafts was noted. Patients’ perceptions of the feeling of the implant included as normal (50%), firm (30%), soft (5%) and hard (15%). Conclusions: GORE-TEX has demonstrated outstanding safety profile in areas of general and vascular surgery. Although encouraging intermediate results are reported, there is a need of more studies to determine the long-term success and
morbidity of GORE-TEX in rhinoplasty. Until then it can be used as an alternative to rather than in preference to autografts. 11:08 AM Efficacy of Thyroid Hormone Suppression for Benign Thyroid Nodules: Meta-analysis of RCTs Matthew T Sdano, MD (presenter); David L Steward, MD; Mercedes Falciglia, MD; Jeffrey Welge, PhD Cincinnati OH; Cincinnati OH; Cincinnati OH; Cincinnati OH
Objectives: Determine the efficacy of thyroid hormone suppressive therapy (THST) for benign thyroid nodule volume reduction. Methods: Systematic search using electronic databases (PubMed, Medline, Cochrane Library) through January 2004, paper review, and contacting experts. Only randomized controlled studies of THST vs no treatment or placebo, for reduction of benign thyroid nodule volume, were included. Exclusion criteria were: ⬍6-month treatment and lack of ultrasound volume measurement. Primary outcome was clinically relevant nodule volume reduction (⬎50%), with a random effects model (RevMan4.2). Results: Eight randomized trials were included (509 subjects). Subjects were 75% more likely to experience ⬎50% nodule volume reduction with THST than placebo or no treatment (relative risk ⫽ 1.76; 95%CI ⫽ 1.15–2.71; P ⫽ 0.01). However, 8 subjects must be subjected to the risk of cardiac and skeletal side effects from THST, for one to benefit from therapy (number-needed-to-treat ⫽ 8, risk difference ⫽ 0.13; 95%CI ⫽ 0.04 – 0.21; P ⫽ 0.003). Sensitivity analysis reveals that 8 null studies would have to have been missed to reverse statistical significance (fail-safe N ⫽ 8). Review of the only study with long-term follow-up (5 years) suggests no significant difference in nodule volume reduction between THST and placebo. Further, studies with follow-up after THST withdrawal demonstrate rapid increase in thyroid nodule and goiter volumes. Conclusions: THST appears more likely than placebo or no treatment to significantly reduce benign thyroid nodule volume, but long-term treatment may be less effective and regrowth is likely following cessation of therapy. Given the risks of THST, routine use is not recommended for benign disease. 11:16 AM Manual Audiometry vs Self-Automated Otogram: A Comparison of Testing Outcomes Mark A D’Agostino, MD (presenter); Jivianne Lee, MD Madison CT; Los Angeles CA
Objectives: Conventional manual audiometry continues to be the primary diagnostic testing method for the determination of hearing sensitivity and degree of hearing loss. How-
MONDAY
were compared to physician measurements. Complications were recorded. The end point of the study was a complete resorption of product. Results: Mean follow-up time was 8 months. Only 2 patients (13%) demonstrated significant product resorption by 6 months; 13/15 patients (87%) were very pleased with the results. Physician and patient results correlated well. Mean pain scores with injection were 4.3 on a 10-point scale. Two patients experienced minor erythema or telangiectasia resolving within to 2 months. Conclusions: Correction of facial lipodystophy with injectable Perlane is a technically simple office procedure that was well tolerated by nearly all patients. The results produced a high level of patient satisfaction with only minor side effects and no late complications. The 2 patients with severe lipodystrophy could not be fully corrected with the standard volumes used. Our results support Perlane to be a feasible option for the provisional correction of mild to moderate facial lipoatrophy.
Scientific Session—Monday P81