BackgroundThe use of nasal irrigation for the treatment of nose and sinus complaints has its foundations in yogic and homeopathic traditions. There has been increasing use of saline irrigation, douches, sprays and rinsing as an adjunct to the medical management of chronic rhinosinusitis. Treatment strategies often include the use of topical saline from once to more than four times a day. Considerable patient effort is often involved. Any additional benefit has been difficult to discern from other treatments.ObjectivesTo evaluate the effectiveness and safety of topical saline in the management of chronic rhinosinusitis.Search strategyOur search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4 2006), MEDLINE (1950 to 2006) and EMBASE (1974 to 2006). The date of the last search was November 2006.Selection criteriaRandomised controlled trials in which saline was evaluated in comparison with either no treatment, a placebo, as an adjunct to other treatments or against treatments. The comparison of hypertonic versus isotonic solutions was also compared.Data collection and analysisTrials were graded for methodological quality using the Cochrane approach (modification of Chalmers 1990). Only symptom scores from saline versus no treatment and symptom and radiological scores from the hypertonic versus isotonic group could be pooled for statistical analysis. A narrative overview of the remaining results is presented.Main resultsEight trials were identified that satisfied the inclusion criteria. Three studies compared topical saline against no treatment, one against placebo, one as an adjunct to and one against an intranasal steroid spray. Two studies compared different hypertonic solutions against isotonic saline.There is evidence that saline is beneficial in the treatment of the symptoms of chronic rhinosinusitis when used as the sole modality of treatment. Evidence also exists in favour of saline as a treatment adjunct. No superiority was seen when saline was compared against a reflexology ‘placebo’. Saline is not as effective as an intranasal steroid. Some evidence suggests that hypertonic solutions improve objective measures but the impact on symptoms is less clear.Authors' conclusionsSaline irrigations are well tolerated. Although minor side effects are common, the beneficial effect of saline appears to outweigh these drawbacks for the majority of patients. The use of topical saline could be included as a treatment adjunct for the symptoms of chronic rhinosinusitis.Plain language summaryNasal irrigation with saline (salt water) for the symptoms of chronic rhinosinusitis.The use of nasal irrigation for the treatment of nose and sinus complaints has its foundations in yogic and homeopathic traditions. It is often prescribed as an adjunct to other treatments such as intranasal steroids or antibiotics. However, there is significant effort involved in preparing and delivering the solutions. This review summarises the evidence for the effect of saline irrigations in the management of the symptoms of chronic rhinosinusitis. There is evidence that they relieve symptoms, help as an adjunct to treatment and are well tolerated by the majority of patients. While there is no evidence that saline is a replacement for standard therapies, the addition of topical nasal saline is likely to improve symptom control in patients with persistent sino‐nasal disease. No recommendations can be made regarding specific solutions, dosage or delivery. There are no significant side‐effects reported in trials.
light signal that allows the high speed and dynamics of signal generation and measurement. It provides the rst test result in 18 minutes and has a maximum throughput of 86 tests per hour. The system can develop both competitive and sandwich-format electrochemiluminescent assays.The Elecsys 2010 system is a fully automated immunoassay analyser that can work in batch, random, or stat modes. The automated process consists of the aspiration of the sample, reagent and microparticles, a rst incubation at 378 C, additional reagent pipetting, a second incubation at 378 C, reaction mixture aspiration, and measurement. The analyser also includes a workstation for system programming and can be interfaced to various laboratory computers. Elecsys 2010 CYFRA 21-1 assayNo pre-analytical preparation of reagents is required for the Elecsys 2101 CYFRA 21-1 assay (cat. no. 1820966). In a rst incubation of nine minutes, 20.m L of sample, a biotinylated monoclonal cytokeratin 19-speci c antibody, and a monoclonal cytokeratin 19-speci c antibody labelled with a ruthenium complex [a tris(2,29 -bipyridyl)ruthenium (II) complex] react to form a sandwich complex. After the addition of streptavidin-coated microparticles, there is a second incubation for nine minutes, and the complex becomes bound to the solid phase via the interaction of biotin and streptavidin. The reaction mixture is aspirated into the measuring cell where the microparticles are magnetically captured onto the surface of the electrode. Unbound substances are then removed with a phosphate-tripropylamine buffer (pH 6.8; Procell ® , BM). Application of a voltage to the electrode then induces chemiluminescent emission, which is measured by a photomultiplier.We agree with Dr Kuropkat regarding the role of CYFRA 21-1 for follow-up in patients with head and neck squamous cell carcinoma (HNSCC). The data including our study have shown that CYFRA 21-1 is a good marker for monitoring therapeutic effect, follow-up and prognostic value in patients with HNSCC.2-5 Furthermore, many studies have shown that CYFRA 21-1 is useful for diagnosis of HNSCC.5-10 We also believe that CYFRA 21-1 is an adjunct for the diagnosis of HNSCC. The CYFRA 21-1 ECLIA provides a useful tool for the surveillance of patients suffering from carcinoma of the head and neck.We have an attention on the dif culty of identication of the appropriate cut-off level. Different methods have different recommended value. Certainly, the different cut-off value ought to be established according to the statistic analysis of an ample study of different tumours.We support Dr Kuropkat's opinion that the survival rate depends on the tumour site. Our study also identi ed this idea, although other explanations are possible. Moreover, we have been investigating the survival rate of our cases studied according to different tumour sites.
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