The epidermal growth factor receptor (EGFR) and type 1 insulin-like growth factor receptor (type 1 IGF receptor or IGF1R) have played an important role in the growth and apoptosis of cancer. The RNA interference (RNAi) technique can suppress gene expression, but the effects of dual silencing of EGFR and type 1 IGF receptor have not been well understood.

pU6-EGFR-shRNA-1, pU6-EGFR-shRNA-2, pU6-IGF1R-shRNA-1 and pU6-IGF-1R-shRNA-2 plasimd vectors were transfected to the nasopharyngeal cancer cells. Seven groups were selected for the study. The protein and downstream protein expression were assessed by Western blot. Apoptosis was determined via flow cytometry. Meanwhile, chemosensitivity of nasopharyngeal cancer cell lines transfeced to chemotherapeutic drugs were carried out by MTT.

In dual silencing of EGFR and IGF-1R, the protein expression much more was decreased than single silencing of EGFR or IGF-1R, but the cell apoptosis much more is increased than single silencing EGFR or IGF-1R. Dual silencing of EGFR and IGF-1R enhanced chemosensitivity to anticancer drugs, compared with single silencing of EGFR or IGF-1R.

Dual silencing of EGFR and IGF-1R are capable of suppressing EGFR and IGF-1R expression of the nasopharyngeal cancer cell and can promote apoptosis and increase the cell sensitivity of anticancer drug. The dual silencing of genes RNAi technique is significantly better than a single gene.

A bifid inferior turbinate is an extremely rare anatomical variation and has been reported in only two cases to date. Including the present report, the uncinate processes were missing in all three patients reported. It is suggested that, in the reported patient, bifid inferior turbinate coexisted with a developmental anomaly of the uncinate process, and that the bifid inferior turbinate represented two separate turbinates originating from the same site.

We present the first reported case of bilateral bifid inferior turbinates, with a secondary middle turbinate, in a patient complaining of nasal obstruction.

We suggest that the superior part of the bifid inferior turbinate may have been formed by severe medial displacement and inferior rotation of the uncinate process, and that the bifid inferior turbinate is an anatomical abnormality of the uncinate process.

To report the safe management and treatment of a catecholamine-secreting tympanicum glomus tumour.

A 73-year-old women presented with a catecholamine-producing glomus tympanicum tumour, complaining of hearing impairment and left ear pain. Physical examination revealed a red, pulsating swelling in the left tympanic membrane. Computed tomography demonstrated a soft tissue mass filling the entire middle-ear cavity and a partial osteolytic lesion in the internal carotid artery. Angiographic examination revealed a densely contrasting tumour with feeding vessels from the ascending pharyngeal artery. Concentrations of serum noradrenalin and urine vanillylmandelic acid (VMA) were high. The tumour was completely resected using a potassium titanyl phosphate laser, the feeding vessels having been embolised the previous day. Concentrations of serum noradrenalin and urine VMA normalised following the operation.

Pre-operative embolisation is useful in the treatment of catecholamine-secreting tympanicum glomus tumours, not only for preventing a hypertensive crisis but also for reducing bleeding. The potassium titanyl phosphate laser is useful for complete resection of the tumour.

The aim of this study was to determine how aware ENT practitioners are that Naseptin® (Alliance), widely used in ENT practice, contains peanut oil and to what extent this is conveyed to patients.

A questionnaire was sent out to all ENT practitioners registered with the British Association of Otolaryngologists.

Analysis of the data confirmed that Naseptin cream is widely used in ENT practice and showed that although most practitioners are aware that Naseptin cream contains refined peanut oil (arachis oil) (74.3 per cent of consultants and 93.6 per cent of registrars) not all ask their patients whether they are allergic to peanuts (62.6 per cent of consultants and 87.3 per cent of registrars).

The results suggest that more should be done to raise awareness amongst practitioners that Naseptin cream contains peanut oil and should be avoided in patients with a peanut allergy, as recommended by national guidelines. The use of Naseptin cream when contraindicated may have medicolegal implications.

To evaluate the benefits of chest computed tomography and X-ray as screening tools in patients with newly diagnosed head and neck squamous cell carcinoma, to determine the incidence of lung metastases or synchronous pulmonary lesions, and to evaluate factors associated with positive radiological findings.

Five-year, retrospective survey of all newly diagnosed cases of head and neck squamous cell carcinoma.

We included 102 patients (63 men and 39 women), with a mean age of 67 years (range 33–91 years). The incidence of pulmonary involvement was 17 per cent. The sensitivity and specificity of computed tomography were 100 and 89.8 per cent, respectively. For chest X-ray, the sensitivity was 35.7 per cent and the specificity 92.7 per cent. The accuracy of computed tomography was 91.5 per cent and that of chest X-ray 83.1 per cent. There was a clear correlation between higher nodal stage and larger tumour with the development of distant metastases. In patients with a positive chest computed tomography scan, 86 per cent had T3 or T4 tumours, in contrast to 38 per cent of those with a negative chest scan (p < 0.05). In addition, 71 per cent of patients with positive findings had N2 or N3 nodal disease, compared with 29 per cent of those with negative findings (p < 0.05).

There is currently no consensus on the use of chest X-ray and computer tomography for screening newly diagnosed cases of head and neck squamous cell carcinoma. We recommend routine scanning of high-staged head and neck squamous cell carcinoma. The National Institute of Health and Clinical Excellence guidelines should be reappraised.

we present the first reported case of parapharyngeal abscess in a child with periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome, an uncommon syndrome of recurrent, self-limiting fever in children.

Case report and review of the literature to date concerning periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome.

Periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome is an incompletely understood syndrome which requires careful and thorough investigation in order to distinguish it from other causes of recurrent fever. There has been much recent debate in the literature over the merits of various treatment strategies, including tonsillectomy.

To the authors' knowledge, this is the first reported case of a parapharyngeal abscess in a child with periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome, made more significant by the fact that the child had undergone tonsillectomy one year prior. This case provides evidence that tonsillectomy does not protect against one of the more serious complications of oropharyngeal infection in children with this syndrome.

Carcinoma cuniculatum is a rare variant of low-grade squamous cell carcinoma. We report the second case of carcinoma cuniculatum of the larynx in the literature.

Case report and review of the world literature concerning carcinoma cuniculatum of the larynx and upper aerodigestive tract.

A histologically proven carcinoma cuniculatum of the larynx is reported in a 72-year-old man. The patient underwent a supracricoid laryngectomy with crico-hyoidopexy, and was free of disease at 70 months after surgery. We emphasise the clinical presentation, histology and therapeutic approach of this rare tumour.

To our knowledge this is the second report in the world literature of carcinoma cuniculatum of the larynx. Carcinoma cuniculatum of the larynx must be considered as a distinct ‘clinicopathological entity’ and close cooperation between the clinician and the pathologist is essential for the correct diagnosis of these tumour as regards to the correct classification and therapy.

Preterm infants with respiratory distress are routinely treated by application of nasal mask continuous positive airway pressure. In preterm infants with cleft lip and palate, nasal mask attachment is not feasible due to air leakage through the cleft defect. Here, we describe a modified continuous positive airway pressure application method that overcomes this problem.

Observation study, university neonatal intensive care unit. The neonates (n = 4) were between 28 and 33 weeks' gestation and weighed 1160 to 1680 g at birth. Immediately after birth, infants with unilateral cleft lip and palate (n = 3) were respiratory stabilised by a Medijet™ generator using a nasal tube. To minimise the pressure cap, hydrocolloid bandages were adhered over the total cleft defect. Immediately after orthodontic passive palatal plates insertion (within 27 hours of life), the nasal tube was removed and continuous positive airway pressure was applied through a nasal mask covering the complete nose of the infant.

The system proved suitable for patients with unilateral cleft lip and palate for whom the generated nasal mask continuous positive airway pressure remained constant between 5 to 7 cm of water but failed in the patient with bilateral cleft lip and palate. None of the patients had to be ventilated due to respiratory failure, and all survived to discharge.

Preterm infants with unilateral, but not bilateral cleft lip and palate, can be successfully stabilised using the described nasal mask continuous positive airway pressure system, thereby avoiding primary intubation and its associated risk of complications.

To review our experience of the treatment of primary tracheal tumours.

All medical notes of patients with primary tracheal tumours diagnosed between 1981 and 2002 were retrospectively analysed.

In this period, 80 patients were diagnosed with primary tracheal malignancy, 48 males and 32 females. The median age was 48 years. Sixty-nine patients had malignant tumours, most commonly adenoid cystic carcinoma (50.7 per cent) or squamous cell carcinoma (30.4 per cent). Fifty-five patients underwent surgery, 30 of whom also received radiotherapy. Twenty-five patients received only radiotherapy. The five-year survival rate for all malignant tumours was 30.5 per cent. The five-year survival rates for adenoid cystic carcinoma and squamous cell carcinoma were 40.2 and 24.6 per cent, respectively. Local recurrence and distant metastases developed in 21 patients (30.4 per cent).

Primary tracheal tumours are rare and mainly malignant. Surgery is the most effective treatment method. Technical advances allow for safe resection of the tumour with a safe, tension-free anastomosis.

We report a rare case of sinonasal hybrid tumour within an inverted papilloma.

The patient's case history and course of management are presented. The relevant medical literature are reviewed and discussed.

A 60-year-old man presented with unilateral nasal obstruction associated with anosmia. An ENT examination revealed a unilateral, left nasal mass. A provisional diagnosis of inverted papilloma was made. The patient underwent a transnasal endoscopic excision of the tumour, which was unfortunately complicated by a cerebrospinal fluid leak. Further treatment of this patient is described. We highlight the features of associated malignancy in inverted papilloma, and the importance of thorough histopathological examination of tissue specimens.

Treatment of inverted papilloma with limited involvement of the skull base can be successfully achieved by endoscopic excision. A high index of clinical suspicion, together with meticulous histopathological examination, will enable diagnosis of associated malignancy. This will ensure that appropriate adjuvant treatment is given, resulting in a good clinical outcome.

We report an atypical case of ossicular necrosis affecting the incus, in the absence of any history of chronic serous otitis media. We also discuss the current theories of incus necrosis.

A male patient presented with a history of right unilateral hearing loss and tinnitus. Audiometry confirmed right conductive deafness; tympanometry was normal bilaterally. He underwent a right exploratory tympanotomy, which revealed atypical erosion of the proximal long process of the incus. Middle-ear examination was otherwise normal, with a mobile stapes footplate. The redundant long process of the incus was excised and a partial ossicular replacement prosthesis was inserted, resulting in improved hearing.

Ossicular pathologies most commonly affect the incus. The commonest defect is an absent lenticular and distal long process of the incus, which is most commonly associated with chronic otitis media. This is the first reported case of ossicular necrosis, particularly of the proximal long process of the incus, in the absence of chronic middle-ear pathology.

We present a rare case of oesophageal perforation following ingestion of over-the-counter ibuprofen capsules.

Case report and literature review of pill oesophagitis.

A previously well, 18-year-old man presented with sudden onset, severe, retrosternal pain, dysphagia and odynophagia following ingestion of over-the-counter ibuprofen capsules. Plain X-ray films and a contrast-enhanced computed tomography scan indicated the diagnosis. The patient was successfully treated with non-operative management.

To our knowledge, this is the first report in the world literature concerning oesophageal perforation with ibuprofen. We discuss pill-induced oesophageal injury and its prevention. Manufacturers, clinicians and patients can all take steps to avoid this potentially life-threatening complication.