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C Polymorphism and Nasal Polyposis
P284
Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
ative imaging serves as an immediate intraoperative quality control to increase the extent of resection and also the percentage of completed removals. The Impact of Prognostic Factors on the Outcome of FESS Ahmed Gamea, MD (presenter) OBJECTIVE: To identify the prognostic factors that may affect the outcome of endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS). METHOD: Study design: Prospective study 68 patients having CRS were studied (over a priod of 2 years) including history taking, endoscopic examination, CT and measurement of nasal nitric oxide (nNO),nasal carbon monoxide (nCO) and total nasal airway resistance. All patients underwent ESS. The specimens were studied histopathologically (for eosinophilia)and bacteriologically (for intracellular S. aureus). RESULTS: Intracellular S. aureus, old age, tissue eosinophilia, and Widal syndrome were found to be associated with a less favorable long-term outcome. In contrast, anatomic variants, allergy, bronchial asthma, and smoking do not seem to affect the prognosis of ESS in patients with CRS. Post-operatively, there was a significant increase in nNO and decrease in nCO production. Patients with polyposis showed less nNO level and olfactory threshold, but higher CT and endoscopic scores. The CT score correlated positively with the endoscopic score, the surgery score, and the degree of tissue eosinophilia. CONCLUSION: 1) The prognostic factors that may affect the outcome of ESS in CRS have been identified. 2) The postoperative increase in nNO and decrease in nCO levels raises the question of whether they can be used to monitor the treatment of CRS like their use in bronchial asthma or not. 3) The olfactory deficit in patients with polyposis is most likely due to mucosal inflammation rather than airway obstruction. Interleukin-6 -174 G/C Polymorphism and Nasal Polyposis Eduardo Macoto Kosugi, MSc, MD (presenter); Cintia Meirelles de Camargo-Kosugi, MSc; Luc Louis Maurice Weckx, MD, PhD; Ismael Dale Cotrim Guerreiro da Silva, MD, PhD; Luiz Carlos Gregorio, MD, PhD OBJECTIVE: To compare the prevalence of the -174 G/C single nucleotide polymorphism between a group of patients with nasal polyposis and a control group. METHOD: Cross-sectional study with two groups (thirty two patients with nasal polyposis and fifty five controls) to investigate the -174 G/C polymorphism in blood samples. Asthma, aspirin intolerance and atopy were main exclusion criteria. IL-6 genotyping was performed using the PCR method with forward primer 5-ATGCCAAGTGCTGAGTCACTA-3 and
reverse primer 5-GGAAAATCCCACATTTGATA-3, amplifying a 226-bp DNA fragment that contained the -174 position. The amplified fragment can be cleaved by restriction enzyme NlaIII when the -174 position presented the C allele in two fragments of 117 and 109-bp, visualized by electrophoresis, classifying participants in GG, GC and CC. Genotype and allele distribution in both groups were compared using the chi-squared test. Study conducted in 2009, at Otorhinolaryngology Department of Sao Paulo Federal University. RESULTS: In the nasal polyposis group, 65.62% of the patients had the GG genotype, while in the control group only 41.82% had the GG genotype, a statistically significant difference, with an odds ratio of 2.65. CONCLUSION: In an IL-6 -174G/C promoter polymorphism study, we observed that the frequency of the GG genotype was higher in NP patients than in controls when asthma, aspirin intolerance and atopy were excluded. We need to study the influence of the -174G/C genotype on IL-6 expression to assess if the GG genotype could really increase inflammation and play a role in NP etiopathogenesis. Intranasal Steroids Delay Repeat Polypectomy Events Yogesh Punekar, PhD (presenter); Azhar Ahmad; Hesham Saleh OBJECTIVE: To compare time to a repeat polypectomy between post-polypectomy intranasal steroids users and non-users. METHOD: Our cohort consisted of patients in GPRD who had undergone at least one nasal polypectomy procedure in or after the year 2000. These patients were followed for a period of up to four years and the time to next polypectomy was estimated. Coxs proportional hazards regression was used to estimate the effect of post polypectomy intranasal steroid treatment on time to the next polypectomy after controlling for other respiratory conditions and their treatment. RESULTS: The cohort consisted of 1,675 patients with a mean age of 58 years and 69% males. Of these, 576 patients were post-polypectomy steroid users and 1,099 patients were steroid non-users. The median time to repeat polypectomy was 812 days among the steroid users and 736 days among steroid non-users. Significantly less proportion of intranasal steroid users experienced a repeat polypectomy (4.1%) compared to steroid non-users (7.8%) (p⫽0.008). This difference was consistent among subgroups of females (2.3% vs 9.1%; p⫽0.006) and concomitant rhinitis treatments users (3.9% vs 19.1%; p⫽0.036). Patients with post polypectomy intranasal steroid use showed lower risk for a repeat polypectomy (Hazard ratio (HR) 0.57; confidence interval (CI) 0.35-0.92; p⫽0.02) compared to steroid non-users. Concomitant rhinitis medication users showed a higher risk (HR: 1.96; CI 1.01-3.81; p⫽0.047) whereas other confounders were not significant. CONCLUSION: Intranasal steroids were effective in delaying a repeat polypectomy. However, further research using a pro-
Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
ative imaging serves as an immediate intraoperative quality control to increase the extent of resection and also the percentage of completed removals. The Impact of Prognostic Factors on the Outcome of FESS Ahmed Gamea, MD (presenter) OBJECTIVE: To identify the prognostic factors that may affect the outcome of endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS). METHOD: Study design: Prospective study 68 patients having CRS were studied (over a priod of 2 years) including history taking, endoscopic examination, CT and measurement of nasal nitric oxide (nNO),nasal carbon monoxide (nCO) and total nasal airway resistance. All patients underwent ESS. The specimens were studied histopathologically (for eosinophilia)and bacteriologically (for intracellular S. aureus). RESULTS: Intracellular S. aureus, old age, tissue eosinophilia, and Widal syndrome were found to be associated with a less favorable long-term outcome. In contrast, anatomic variants, allergy, bronchial asthma, and smoking do not seem to affect the prognosis of ESS in patients with CRS. Post-operatively, there was a significant increase in nNO and decrease in nCO production. Patients with polyposis showed less nNO level and olfactory threshold, but higher CT and endoscopic scores. The CT score correlated positively with the endoscopic score, the surgery score, and the degree of tissue eosinophilia. CONCLUSION: 1) The prognostic factors that may affect the outcome of ESS in CRS have been identified. 2) The postoperative increase in nNO and decrease in nCO levels raises the question of whether they can be used to monitor the treatment of CRS like their use in bronchial asthma or not. 3) The olfactory deficit in patients with polyposis is most likely due to mucosal inflammation rather than airway obstruction. Interleukin-6 -174 G/C Polymorphism and Nasal Polyposis Eduardo Macoto Kosugi, MSc, MD (presenter); Cintia Meirelles de Camargo-Kosugi, MSc; Luc Louis Maurice Weckx, MD, PhD; Ismael Dale Cotrim Guerreiro da Silva, MD, PhD; Luiz Carlos Gregorio, MD, PhD OBJECTIVE: To compare the prevalence of the -174 G/C single nucleotide polymorphism between a group of patients with nasal polyposis and a control group. METHOD: Cross-sectional study with two groups (thirty two patients with nasal polyposis and fifty five controls) to investigate the -174 G/C polymorphism in blood samples. Asthma, aspirin intolerance and atopy were main exclusion criteria. IL-6 genotyping was performed using the PCR method with forward primer 5-ATGCCAAGTGCTGAGTCACTA-3 and
reverse primer 5-GGAAAATCCCACATTTGATA-3, amplifying a 226-bp DNA fragment that contained the -174 position. The amplified fragment can be cleaved by restriction enzyme NlaIII when the -174 position presented the C allele in two fragments of 117 and 109-bp, visualized by electrophoresis, classifying participants in GG, GC and CC. Genotype and allele distribution in both groups were compared using the chi-squared test. Study conducted in 2009, at Otorhinolaryngology Department of Sao Paulo Federal University. RESULTS: In the nasal polyposis group, 65.62% of the patients had the GG genotype, while in the control group only 41.82% had the GG genotype, a statistically significant difference, with an odds ratio of 2.65. CONCLUSION: In an IL-6 -174G/C promoter polymorphism study, we observed that the frequency of the GG genotype was higher in NP patients than in controls when asthma, aspirin intolerance and atopy were excluded. We need to study the influence of the -174G/C genotype on IL-6 expression to assess if the GG genotype could really increase inflammation and play a role in NP etiopathogenesis. Intranasal Steroids Delay Repeat Polypectomy Events Yogesh Punekar, PhD (presenter); Azhar Ahmad; Hesham Saleh OBJECTIVE: To compare time to a repeat polypectomy between post-polypectomy intranasal steroids users and non-users. METHOD: Our cohort consisted of patients in GPRD who had undergone at least one nasal polypectomy procedure in or after the year 2000. These patients were followed for a period of up to four years and the time to next polypectomy was estimated. Coxs proportional hazards regression was used to estimate the effect of post polypectomy intranasal steroid treatment on time to the next polypectomy after controlling for other respiratory conditions and their treatment. RESULTS: The cohort consisted of 1,675 patients with a mean age of 58 years and 69% males. Of these, 576 patients were post-polypectomy steroid users and 1,099 patients were steroid non-users. The median time to repeat polypectomy was 812 days among the steroid users and 736 days among steroid non-users. Significantly less proportion of intranasal steroid users experienced a repeat polypectomy (4.1%) compared to steroid non-users (7.8%) (p⫽0.008). This difference was consistent among subgroups of females (2.3% vs 9.1%; p⫽0.006) and concomitant rhinitis treatments users (3.9% vs 19.1%; p⫽0.036). Patients with post polypectomy intranasal steroid use showed lower risk for a repeat polypectomy (Hazard ratio (HR) 0.57; confidence interval (CI) 0.35-0.92; p⫽0.02) compared to steroid non-users. Concomitant rhinitis medication users showed a higher risk (HR: 1.96; CI 1.01-3.81; p⫽0.047) whereas other confounders were not significant. CONCLUSION: Intranasal steroids were effective in delaying a repeat polypectomy. However, further research using a pro-