Evaluating the sensation of nasal obstruction with acoustic rhinometry and rhinomanometry

The relationships among subjective sensation of nasal obstruction, data of rhinomanometry and acoustic rhinometry between individuals or for each individual were explored. Thirty-nine subjects with nasal obstruction problems were examined using the visual analogue scale, nasal airflow resistance (NAR), nasal minimal cross-sectional area (MCA), and nasal cavity volume (NCV). No significant correlation was found between the sensation of unilateral or bilateral nasal obstruction to NAR, MCA, or NCV. Strong correlations between MCA and NAR, and NCV and NAR were noted in this study. Another 10 healthy volunteers were investigated and correlation was studied on each individual level. Strong correlations within subject were found more commonly in persons with short-term follow-up than with the long-term follow-up group. In the present study, rhinomanometry results were compatible with acoustic rhinometry results. However describing the sensation of nasal patency with only rhinomanometric or acoustic rhinometric measurements seems still inadequate.     

Evaluation of the cochlear aqueduct patency: comparison of 2 noninvasive techniques

Variations in cephalo-rachidian fluid pressure can be transmitted to the middle ear through the cochlear aqueduct (CA). This gives us a non-invasive manner to evaluate any changes in fluid pressure by measuring middle ear impedance (impedancemetry). The present study compared two indirect methods for measuring intracranial pressure: a) impedancemetry during evoked jugulo-tympanic reflex (JTR) and b) study of the tympanic membrane (TM) fine motility using a MMS-10 analyzer. The latter is a new procedure involving the indirect evaluation of the fluid pressure. In fact, when the CA is open the labyrinthine fluid pressure is transmitted to the oval window, the stapes platina and, finally, to the tympanic membrane where it can be measured with an MMS-10 unit. This equipment can measure nanoliter shifts in the TM. In particular, comparison between the clinostatic and orthostatic tympanic motility measurements enable one to establish whether the CA is patent or not. In the present study 15 subjects were examined using both a) impedancemetry during jugular compression and b) analysis of the TM shift using an MMS-10 unit. In 14 of the 15 cases there was good correlation between the data obtained using both methods: in all but one case it proved possible to record a JTR-induced variation in impedance whenever the MMS-10 indicated that the CA was open. The results suggest that, in clinical practice, the two methods can be used in parallel for non-invasive monitoring of variations in intracranial pressure in patients with neurological involvement. On the other hand, in the E.N.T. field these techniques could be used to study inner ear pathologies causing dynamic alterations of the endolabyrinth fluids (endolymphatic hydrops, labyrinthine fistula).     

Diagnostic value of nasal provocation testing and rhinomanometry in allergic rhinitis

Assessment of the hemodynamic and anatomic results following balloon angioplasty of discrete native coarctation of the aorta, with particular attention to "remodeling," has required repeat cardiac catheterization and angiography, which is invasive and has limited resolution. Eight patients with hypertension and discrete native coarctation with an otherwise normally developed aortic arch underwent angioplasty at 5.0 +/- 6.8 years of age. Angiographic cross-sectional areas of the aorta indexed to body surface area at the isthmus (I), coarctation site (C), and 1 cm distal to the coarctation site (Cd) pre- and postangioplasty were compared with MRI-indexed cross-sectional areas 18 +/- 10 months (MRI-1) and 35 +/- 11 months (MRI-2) postangioplasty. From preangioplasty to MRI-2, the isthmus was smaller (149 +/- 22 versus 127 +/- 27 mm2/m2; p < 0. 05). The coarctation site was larger postangioplasty (25 +/- 9 versus 116 +/- 40 mm2/m2; p < 0.001) with continued growth at latest follow-up (116 +/- 40 versus 164 +/- 36 mm2/m2; p < 0.01). The segment 1 cm distal to the coarctation site continued to decrease in area at latest follow-up (267 +/- 78 versus 163 +/- 38 mm2/m2; p < 0. 001). I versus C versus Cd at MRI-2 were similar, whereas postangioplasty and MRI-1 cross-sectional area measurements were significantly different. Following angioplasty of discrete native coarctation, the aorta becomes more uniform or undergoes "remodeling." Noninvasive MRI is an effective means of evaluating the anatomic result following balloon angioplasty, obviating the need for repeated invasive cardiac catheterizations.     

Evaluation of nasal passage patency after antigen and histamine challenge in guinea pigs by acoustic rhinometry

Persistent pain after distal claviculectomy (the Mumford procedure) has been attributed to both inadequate and excessive clavicle resection or incomplete supraspinatus outlet decompression with continued impingement. A retrospective review of twenty glenohumeral arthroscopies done in shoulders with a previous Mumford procedure disclosed 15 cases, (75%) of superior glenoid labrum, long head biceps tendon (SLAP) lesions. Most of the distal calvicle resections 13 out of 15 (86%) had been done for "acromioclavicular arthritis." These patients were young, with an average age of 37 years (range 20 to 50) and most, 14 out of 15, had pain attributable to a specific traumatic event. Most had deep pain referable to the bicipital groove with cross chest adduction of the shoulder with the elbow extended and forearm pronated (thumb down). The discomfort improved with the forearm supinated (thumb up). It is concluded the SLAP lesion to be part of the differential diagnosis of acromioclavicular joint disease. In younger patients with a traumatic history, glenohumeral arthroscopy should be used to rule out SLAP pathology and possibly prevent an unnecessary distal clavicle resection.     

An evaluation of nasal patency with acoustic rhinometry--preop. and postop. comparisons

PURPOSE: This prospective study was designed to assess the effect of primary hyperparathyroidism on heart muscle, valves, and myocardial function. Echocardiography was used to evaluate changes in mechanical performance, the thickness of the left ventricular wall, myocardial calcific deposits, and valvular calcifications in patients with primary hyperparathyroidism. METHODS: Echocardiography was performed in 54 patients with hyperparathyroidism prior to surgery and 12 +/- 2 months after successful parathyroidectomy. A matched control group was followed for comparison. RESULTS: In a blinded fashion, aortic and mitral valve calcifications were detected in 63% and 49% of patients with primary hyperparathyroidism (controls: 12% and 15%, respectively). Calcific deposits in the myocardium were found in 69% of patients with hyperparathyroidism and 17% of the control subjects. After parathyroidectomy and 12 months of normocalcemia, a significant regression of left ventricular hypertrophy (p < 0.001) was observed. CONCLUSIONS: The present data show a high incidence of left ventricular hypertrophy, calcific deposits in the myocardium, and/or aortic and mitral valve calcification in patients with primary hyperparathyroidism. A 1-year follow-up after parathyroidectomy (and restoration of normocalcemia) discloses regression of hypertrophy, while calcifications persist without evidence of progression.     

Sj?gren syndrome: comparison of assessments with MR sialography and conventional sialography

We investigated the effects of genes controlling melanism on levels and patterns of activity, potential nonvisual components of fitness, of adult Mediterranean flour moths, Ephestia kuehniella Zeller (1879). Six genotypes of two melanic strains (Ala nigra and black) were used. We monitored continuously the walking or flight activity of 45 mated females per genotype during the third night of their lives, using automatic electrostatic techniques to carry out the measurements. Although there was high individual variation within genotypes, bb (melanic) females were more active than the two nonmelanic genotypes of the black strain (b+, ++) because they tended to show more bouts of activity. There were no differences in the average length of these bouts, or in the timing of initial and final activity. Overall, the females of the black strain were significantly more active than the females of the Ala nigra strain. The results are discussed in the context of the evolution of melanism in moths. Copyright 1998 The Association for the Study of Animal Behaviour     

MR of hippocampal sclerosis: comparison of qualitative and quantitative assessments

We describe a patient with dysgerminoma who had elevated serum inhibin, tumor-associated trypsin inhibitor (TATI), and CA 125 concentrations, which increased progressively during follow-up of the advancing disease. Inhibin levels correlated closely with disease behavior. In contrast to inhibin, serum TATI and CA 125 failed to reveal the presence of silent disease.     

Clinician assessments of patient difficulty.

Studied global judgments of case difficulty made by expert clinicians (a psychiatrist, a psychologist, and a social worker) after viewing a complete session of psychotherapy. The 2nd session of 48 short-term (12 sessions) psychotherapy patients with posttraumatic stress disorder, adjustment reaction, major depressive episode, panic disorder, or uncomplicated bereavement was videotaped for judging. Difficulty was conceptualized as a subjective sense of the amount of effort the clinician would have to apply in the treatment of the case. Results show that difficulty ratings by the clinicians correlated most strongly with 2 variables—the patient's pretherapy level of self-reported symptomatic distress (measured by the SCL-90) and the extent to which the patient presented the therapist with double-binding relationship dilemmas, as rated by independent clinicians. Patient difficulty was also modestly correlated with therapy outcome. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of unilateral nasal patency on the contralateral side

This investigation was designed to verify the possible feed-back mechanism which works to compensate for changes in the nasal volume of one side by the other side. Acoustic rhinometry, with which nasal volume is easily evaluated, was used in this investigation. Acoustic rhinometry was performed at 4 points in time (immediately after, and three, six and nine minutes after, the setting of experimental conditions). This investigation was composed of two studies. In the first study, ten healthy subjects (nine males and one female, 26-49 years of age, mean age 30 years) were evaluated to estimate the effect of decreased unilateral nasal patency upon the other side. In this study, one nasal cavity was occluded with an acryle plug, and the nasal volume of the other side was evaluated by acoustic rhinometry before and after the occlusion. In the second study eight healthy subjects (five males and three females, 24-34 years of age, mean age 29 years) were evaluated to estimate the effect of increased unilateral nasal patency upon the other side. This study covered a period of three days. A small piece of cotton soaked in a vasoconstrictor solution (1/1000 adrenalin or 0.05% naphazolin nitrate) was put in one nasal cavity (the right on the first day, the left on the second day) and the other side was evaluated before and after administration of the solution. On the third day of the control study, a similar piece of cotton soaked in physiological saline solution was put in one nasal cavity, and the other side was evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of acoustic rhinometry and posterior rhinomanometry as tools for inhalation challenge studies

Objective measures of upper respiratory function are needed to understand the effects of inhaled toxicants on the nasal passages. Acoustic rhinometry (AR) is a simple new technique that determines nasal volume by measuring the cross-sectional area of the upper airway as a function of the distance along the nasal passage. This study compares acoustic rhinometry with the more traditional posterior rhinomanometry (NAR) and correlates these objective measures with the symptom of nasal congestion. Healthy young adults (n = 29) were studied on 4 days, each separated by at least 1 wk, in a climate-controlled environmental chamber for 6 h, with exposure to clean air or sidestream tobacco smoke (SS) (2 h, 1, 5, and 15 ppm CO). The coefficient of variation for single measurements was 8-15% (AR) and 4% (NAR); for across-day measurements it was 15-25% (AR) and 13-15% (NAR); and for between days it was 19-27% AR and 17-21% (NAR). These coefficients were similar in subjects with a history of environmental tobacco smoke sensitivity (ETS-S) and those with no history of ETS sensitivity (ETS-NS). At baseline, the perception of unilateral nasal congestion was significantly correlated with unilateral nasal dimensions or nasal resistance; the symptom of baseline bilateral nasal congestion (estimated for both nasal passages simultaneously) correlated less well with objective measures of nasal patency. Under challenge conditions (SS at 1-15 ppm CO), there were typically significant correlations between changes in unilateral congestion and both unilateral rhinomanometry and acoustic rhinometry, but correlations of bilateral congestion and measurable dimensions were much lower. ETS-S and ETS-NS subjects differed in correlations between bilateral subjective and objective measures: ETS-S subjects showed significant correlation between baseline congestion and NAR; in contrast, ETS-NS subjects showed significant correlation between baseline congestion and acoustic rhinometry. These results indicate that NAR and AR are complementary tests for use in inhalation challenge studies and have different correlations with nasal congestion under baseline and challenge conditions.     

Validation of computer-mediated open-ended standardized patient assessments

Quantitative information regarding the development of students' clinical reasoning skills is valuable in assessing third- and fourth-year medical students' clinical knowledge. Standardized patient cases are often used to obtain this quantified information. These cases typically involve a post-patient examination consisting of a series of closed-ended multiple-choice questions. Many medical educators question whether the results from the closed-ended multiple-choice questions truly reflect students' clinical knowledge and reasoning proficiency. Since 1995, the Kirksville College of Osteopathic Medicine (KCOM) has used a computer program, SOAP Note Plus, for standardized patient assessment of students to automate the post-encounter documentation and evaluation. This paper describes the development of the SOAP Note Plus program and a validation study which was conducted to determine the empirical association between the computer-mediated closed-ended and open-ended post-encounter standardized patient assessments. Correlation and GENOVA statistics were used in the analysis of the performance of third-year medical students on the closed-ended and the open-ended assessments following standardized patient encounters and the relationship to their undergraduate GPA, first 2-year medical school GPA and the actual clinical rotation evaluations. The initial results show the positive relationship between the open-ended assessment and the actual clinical rotation evaluations. undergraduate GPA and the first two-years of medical school GPA.     

Role conflicts in coercive assessments: Evaluation and recommendations.

The role requirements of psychologists working in the coercive situation of the criminal justice system are compared and contrasted with those of the voluntary, or "free-world," setting. In particular, the place and function of psychological assessments are considered in both settings, as are the kinds of professional relationships that are permitted by the two types of employment contexts. I maintain that because psychologists potentially suffer from more role conflict and ambiguity in the coercive environment than in the free-world assessment situation, they are prone to display their unconscious biases and distortions more readily. Three kinds of these distortions are described and illustrated. A model to partly correct for these distortions is recommended; it follows the adversarial approach of the criminal justice system itself. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

External dacryocystorhinostomy without mucosal flaps: comparison of petroleum jelly gauze nasal packing with gelatin sponge nasal packing

BACKGROUND AND OBJECTIVE: This study was designed (1) to determine the overall success of patients who underwent external dacryocystorhinostomy (DCR) using a modified Kasper technique without lacrimal sac and nasal mucosal sutured flaps, and (2) to investigate the possible impact of intraoperative petroleum jelly gauze nasal packing as compared with gelatin sponge nasal packing on the surgical results. PATIENTS AND METHODS: A retrospective review of 122 consecutive patients who underwent external DCR using a modified Kasper technique was performed. Patients were divided into two groups based on use of petroleum jelly gauze packing or gelatin sponge packing. Criteria for successful surgery included resolution of the main symptom(s) of tearing, chronic mucous discharge (chronic dacryocystitis), and/or recurrent acute dacryocystitis; and patency of the reconstructed lacrimal system. RESULTS: Ninety-four of 96 patients who had petroleum jelly gauze packing had successful DCRs, whereas only 21 of 26 patients who had gelatin sponge packing had successful DCRs (P < .005). Soft tissue rather than bony obstruction of the rhinostomy was the most common cause of DCR failure, as confirmed by office probing, endoscopy, and computed tomography. Three patients in the gelatin sponge packing group who experienced failure subsequently had bacterial sinusitis. CONCLUSION: This study strongly suggests that gelatin sponge nasal packing, at least when used for patients who undergo DCR without sutured mucosal flaps, may be associated with an increased number of failures as a result of scar tissue formation at the rhinostomy site, as compared with petroleum jelly packing. Petroleum jelly gauze nasal packing may enhance surgical results by reducing scarring between the lacrimal sac fistula and the nasal structures.     

Field examination of the equine patient with nasal discharge

This article describes the field investigation of horses with nasal discharge (serous, purulent, blood and feed). Flow charts on how to evaluate affected horses, and photographs of the examination procedures and of horses affected with nasal discharge are included.     

The effect of patient and clinician ideology on clinical judgment: A study of ideological countertransference.

Examined the influence of patient and clinician values on clinical judgment, using 363 clinical psychologists. Ss each rated 2 case histories. One case had been altered to reflect 1 of 4 conditions (right-wing [RW] religious, RW political, left-wing [LW] religious, or LW political), and the other case reflected no ideological commitment. Cases with "extreme" ideologies were rated more negatively on 4 clinical judgment decisions. Unexpectedly, ideological cases were almost 3 times more likely to be diagnosed obsessive-compulsive and were less likely to be diagnosed with generalized anxiety disorder than nonideological cases. Clinicians need to be sensitive to issues of "ideological countertransference." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acromesomelic dwarfism: description of a patient and comparison with previously reported cases

SPF-male rats were treated intraperitoneally with phenobarbital (30 mg/kg/day) or 0.9% sodium chloride for 4 days. Endogenous creatinine clearance in conscious rats and inulin clearance in nondiuretic rats under inactin anesthesia were measured 24 hr following the last injection. In an additional group of treated rats diuresis was induced by sodium chloride and mannitol and then inulin- and PAH clearance were measured simultaneously. Following 4 days treatment with phenobarbital, endogenous creatinine clearance and inulin clearance were not significantly different in control and phenobarbital-treated animals. In contrast significant changes were found in urine volume and PAH clearance in the phenobarbital-treated animals. These results do not reflect any change in glomerular filtration rate, but might be attributed to an increase in renal plasma flow or an activated tubular transport system following phenobarbital administration.     

Preoperative anxiety and fear: a comparison of assessments by patients and anesthesia and surgery residents

We sought to compare self-assessment of preoperative anxiety levels and selection of worst fears by surgical patients with the assessments made by the anesthesia and surgery residents providing intraoperative care for those patients. One hundred inpatients at a Veterans Affairs hospital (Group 1) and 45 patients at a University hospital (Group 2) were asked to complete a brief questionnaire; the residents were asked to complete the same questionnaire. Group 1 results showed that median patient visual analog scale (VAS) scores were lower for anxiety about anesthesia compared to surgery (16 vs 22, P < or = 0.05). Anesthesia resident VAS scores were higher than patient or surgery resident scores. Neither type of resident was able to predict their individual patient's VAS score (Kendall's tau). The fear chosen with the greatest incidence by Group 1 patients and residents was "whether surgery would work". A significant number of residents (34%, anesthesia or surgery, P < or = 0.05) matched their patient's fear choice. Residents commonly chose fears related to their specialty (e.g., anesthesia residents chose anesthesia-related fears more often than surgery residents, 50% vs 28%, P < or = 0.001). In Group 2, residents demonstrated an improved ability to predict patient scores. For instance, both surgery and anesthesia residents were able to predict individual University patient VAS scores (P < or = 0.01). The fear chosen with the greatest frequency by Group 2 patients was "pain after the operation". Sixty percent of anesthesia residents matched their patients' fear choice (P < or = 0.001). This study indicates a variable ability of anesthesia and surgery residents to predict patient anxiety and fear which may be due, in part, to difficulty in understanding a Veterans Affairs hospital patient population.     

Needs of the psychiatric patient population in secondary and tertiary prevention: point of view of a clinician

The concept of need, discussed from many points of view, remains necessary to the planning of health services. The author tries to define psychiatric needs in a clinical perspective, limiting his approach to secondary and tertiary prevention. The critical points supporting the clinical decision permit the choice of fundamental criteria which allow one to identify and describe the psychiatric needs of a given population. Using this methodology a typology of those needs is formulated in a way which is acceptable in a multidisciplinary approach.     

Effects of clinician theoretical orientation and patient explanatory bias on initial clinical judgments.

18 behavioral (mean age 27.89 yrs), 18 cognitive (mean age 25.78 yrs), and 18 psychodynamic (mean age 29.22 yrs) clinical trainees viewed a videotaped intake interview with a female actress who explained her fear of going on elevators according to 1 of 3 explanatory biases: learned reactions, faulty thoughts, or underlying conflicts. After viewing the tape, Ss made judgments about the patient's responsiveness to therapy. Across all 3 experimental conditions, psychodynamic Ss expressed more "pessimistic" prognoses than both behavioral and cognitive Ss, who did not differ. However, among psychodynamic Ss, those who viewed the patient whose explanatory bias was consistent with a psychodynamic orientation were less pessimistic than were their colleagues exposed to patient explanatory biases inconsistent with a psychodynamic orientation. Implications for client–therapist matching, clinical training, and rapprochement between orientations are discussed. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)