Reconstruction of nasal defects with implant-retained nasal prostheses

BACKGROUND: Exercise testing with multigated acquisition technetium radionuclide cineangiography (MUGA) is a useful modality that can discriminate systolic and diastolic performance in patients with ischemic heart disease. However, some patients may have abnormal left ventricular filling dynamics with normal regional and global systolic function. HYPOTHESIS: The purpose of the study was to assess exercise-induced diastolic dysfunction as expressed by a prominent atrial (A) wave or diastasis deflection at the left ventricular volume curve, in patients with different degrees of ischemic heart disease. METHODS: In all, 32 men and 7 women aged 35-70 years (mean 54 +/- 8.6 years) underwent MUGA at rest and during exercise for analysis of the radionuclide volume curve. Within 6 weeks, thallium-201 scintigraphy and coronary angiography were performed and the patients were categorized into three groups: (1) disease-free (n = 10), (2) single-vessel disease (> 50% stenosis) (n = 19), and (3) double-vessel disease or more (n = 10). A waves or diastasis deflections were compared among the groups. RESULTS: Significant differences (p < 0.01) were noted in A-wave deflection relative to peak diastolic volume curve during exercise (Aexe/T) between Group 1 and Groups 2 and 3. Group 1 manifested only a mild rise in A-wave deflection from rest (20.20 +/- 8.49%) to exercise (25.85 +/- 8.49%), whereas Groups 2 and 3 exhibited a significant increase from 25.89 +/- 9.55% and 28.40 +/- 12.6%, respectively, to 60.21 +/- 22.5% and 63.0 +/- 22.86%, respectively. Group 2 had a significantly (p < 0.05) higher maximal heart rate than Group 3. CONCLUSIONS: The addition of prominent A-wave or diastasis deflection to a normal systolic response during exercise testing with multigated radionuclide cineangiography might be a sensitive marker of coronary artery disease. The A wave represents diastolic dysfunction of the left ventricle, considered an early event in the ischemic cascade.     

Fibrinolytic components in nasal mucosa and nasal secretion

Effects of a newly synthesized antiulcer agent, YJA20379-4, on gastric proton pump (H+/K+-ATPase) activity, Helicobacter pylori (H. pylori) growth, gastric acid secretion, and gastro-duodenal lesions, were examined in comparison with those of omeprazole. YJA20379-4 markedly inhibited the H+/K+-ATPase activity in a concentration-dependent manner and the inhibitory effect was increased under a weak acidic condition; the IC50 values were 32 and 81 microM at pH 6.4 and 7.4, respectively. The inhibition was completely antagonized by 0.5 mM dithiothreitol (DTT). In addition, YJA20379-4 showed a significant anti-H. pylori activity determined by the agar dilution method. The value of minimum inhibitory concentration (MIC, 3.9-11.7 microg/ml) was at least 3 times more potent than that of omeprazole. In pylorus ligated rats, YJA20379-4 inhibited basal gastric acid secretion when administered by the intraduodenal route (ED50: 23.6 mg/kg). In experimental ulcer models, YJA20379-4 administered by the oral route dose-dependently prevented the development of gastro-duodenal lesions in rats. Moreover, repeated administration of YJA20379-4 promoted the healing of gastric ulcers induced by acetic acid. On the basis of the data obtained, it is suggested that YJA20379-4 has a wide spectrum of antiulcer activities, and its mode of antiulcer actions is dependent on the inhibition of H+/K+-ATPase activity and H. pylori growth and the enhancement of a mucosal defense. Thus, YJA20379-4 might prove to be a beneficial therapy for gastritis and peptic ulcer diseases.     

Collapse of the nasal endotracheal tube in the nasal cavity

A 27-year-old female with maxillary maldevelopment was admitted for mandibular sagittal splitting osteotomy with mandibular progeny. General anesthesia was induced with 100 mg of propofol and 8 mg of vecuronium. When a soft and preformed 7.0 mm North-Polar-nasotracheal tube (Portex) was inserted into the nasopharynx through the left nasal cavity, it was very difficult to advance beyond the choana. After nasotracheal intubation, the buking became harder than before when she had been ventilated with a face mask. The peak airway pressure had reached higher than 50 cmH2O with ventilation of 500 ml tidal volume. Bronchoscopy revealed that the fiberscope (3.5 mm O.D.) could not go through the choanal stenosis, because it was too narrow. Therefore, she had to be intubated by a spiral tube, 6.0 mm I.D., through the other nasal cavity with assistance of bronchoscopy, instead of the North-Polar-tube. So, we have to pay attention to the possibility of compression and collapse of a soft nasotracheal tube in the nose of the patient with choanal stenosis due to maxillary maldevelopment.     

Headaches associated with nasal obstruction due to deviated nasal septum

A deviated nasal septum not only can cause a blocked nose, but may also be associated with headaches. This study evaluates the nature of these headaches, the effect of submucous resection of the nasal septum, and the factors associated with postoperative headache relief. Deviated nasal septa were corrected by submucous resection in 99 men and 17 women. Patients were studied at 4 to 48 months (mean 18 months) postoperatively. Fifty-five of the 116 patients studied (47.4%) had preoperative recurring headaches. Thirty-five of the 55 patients with headaches (63.6%) experienced relief (complete or partial) of their headaches at a mean follow-up period of 18 months. Patients were more likely to be relieved of their headaches following submucous resection if the headaches were most intense over the frontal region, pressurelike in nature, and if the submucous resection resulted in relief of nasal obstruction. It is possible that headaches recur in the long term, and it is postulated that central mechanisms play a role.     

Role of the external nasal dilator in the management of nasal obstruction

The aim of this study is to evaluate the effect of an external nasal dilator in patients with nasal obstruction secondary to mucosal congestion (n = 33) or to septal deviation in the nasal valve area (n = 28). A group of subjects with healthy nasal cavities was tested also (n = 51). Acoustic rhinometric and rhinomanometric nasal measurements were performed with and without the dilator and before and after topical decongestion of the nasal mucosa. A visual analog scale was employed to evaluate the subjective sensation of nasal obstruction. Objective measurements showed that the external dilator increased the minimum cross-sectional area and decreased the nasal resistance significantly in all three groups (P < 0.01). The effect was more impressive in patients with septal deviation (P < 0.001). Subjective assessments reflected patency in all subjects except those in the mucosal swelling group (P = 0.06). From this study the authors conclude that the external nasal dilator offers an effective, nonsurgical therapeutic approach in the management of septal deviation that obstructs the nasal valve area. Although patients with nasal obstruction secondary to mucosal congestion showed objective improvement with the nasal dilator, these changes were not accompanied by a sensation of enhanced patency.     

Effects of the Breathe Right nasal strips on nasal ventilation

Erythropoietin (EPO) is the hematopoietic growth factor that regulates red cell production. There is a direct relationship between its secretion and tissue hypoxia. Above sea level, oxygen concentration diminishes. This causes an increase of hemoglobin and hematocrit; this effect could be the consequence of higher EPO levels. Currently, evaluation of baseline serum EPO levels is very important in the differential diagnosis of anemia and erythrocytosis. The purpose of the present work was to report the EPO levels on a group of healthy blood donors living in Mexico City, 2,240 m above sea level. Two-hundred twenty blood donors were selected to measure serum EPO; there were 168 males and 52 females. Median EPO levels of the entire population were 7.5 mU/mL (percentile interval, PI, 1-18). Median EPO levels were 7.6 (PI 1-18) and 7.5 (PI 1-16.9) for men and women, respectively. We did not find differences in serum EPO levels among previous reports in other populations and the values determined in this study.     

Diagnostic nasal endoscopy

Endoscopy has gained wide popularity due to its protean applications and efficacy in many surgical specialties. Diagnosis and treatment of nasal diseases have advanced in the process. However, proper training in nasal endoscopy is critical. The nose is an intricate organ fundamentally and has such proximity to other vital structures that procedural miscues can cause serious complications. This paper traces the historical development of nasal endoscopy, explains its rationale, reviews anatomic and diagnostic issues, and describes the selection of equipment and correct application of technique, emphasizing the potential for advanced diagnostic skills.     

Chondrosarcoma of the nasal septum

120 pieces of silk suture (1# & 4#) were sterilized with formaldehyde at different time period. Group II and III each had 20 pieces and was disinfected with ethylene oxide or high pressure respectively. The tension of each silk suture was measured with tensomether. The result showed that there was no significant difference compared with the control groups (P > 0.05). This suggests that silk suture maintains the same tension in the experiments after repeated sterilization with formaldehyde, with ethylene oxide, or with highpressure sterilization once.     

Surgery of the nasal tip

To accurately interpret heart rate variability (HRV) including circadian rhythm from Holter ECG, the simultaneous assessment of physical activity, which significantly affects HRV, is essential. In this study, to obtain this simultaneous assessment, the fundamental problems in implementing an accelerometer in a commercial Holter recorder were studied. In a treadmill exercise, three axial outputs of an accelerometer showed highly linear correlations with the running speed (correlation coefficient; vertical 0.94, forward-backward 0.97, sideways 0.97, three-dimensional amplitude 0.96, n = 8). The vertical acceleration showed a slightly sigmoidal increase with speed. Against a slope change, no significant increase in acceleration was observed except in the forward-backward direction. Individual calibration was found to be needed for the accurate estimation of physical load from body acceleration. A simplified calculation with the sum of the three axial absolute values correlated highly with the three-dimensional (3D) acceleration which shows the most reliable response to motions in any direction (r = 0.98, the slope of the regression line = 0.97) and, with this relation, the estimated 3D amplitude showed a sufficient degree of agreement. This substituted calculation was used in the Holter recordings. To know the posture of subjects, a piezoresistive accelerometer with the function of clinometer was used in another study. From played-back Holter recordings, the R-R interval and body acceleration were simultaneously sampled. The serial changes of both the power spectra of HRV and the body acceleration were observed over a 24 h period. Some cases with an abnormally reduced high-frequency component (HF) of HRV at night or an unusually high HF in the daytime were explained by physical conditions estimated with the accelerometer. The simultaneous assessment of patients' physical state by the present method provides the accurate interpretation of circadian rhythm in HRV.     

Angiosarcoma of the nasal septum

This is a report on a female patient, 37 years old, with a polypous, sessile tumor on the nasal septum covered by smooth mucous membrane. She was treated with local excision. The histological diagnosis was an angiosarcoma, confirmed by immunohistological stain with factor VIII-like antigen, thrombomodulin, and UEA. She currently remains free of the disease 12 months after diagnosis. Angiosarcoma in the head and neck area and especially the localization in the nasal septum are extremely rare. Prognosis, differential diagnosis, metastasis formation, and therapy of this tumor are presented.     

Aspergilus nasal sinusitis endoscopic surgery

Five cases of non-invasive fungal sinusitis were reported. Among them were 2 cases of maxillary, 2 of maxillo-ethmoid and sphenoid sinus. All the patients were operated under endoscopic intranasal approach. The pathological diagnosis of all 5 cases was aspergills infection. The pathogenesis were conditional such as unclean working situation, deviation of nasal septum, polyposis and infection. The disease was easily confused with common infectious disease. The pathogenic factor, diagnosis and treatment were discussed.     

Chondrosarcoma of the nasal septum

A case of chondrosarcoma of the nasal septum is presented with the result of treatment. The patient was admitted for a growth in the nose of four years' duration. Fine needle aspiration for cytological examination was suggestive of squamous cell carcinoma. She was treated with lateral rhinotomy and wide excision followed by septorhinoplasty. Histological examination showed that the lesion was chondrosarcoma. The patient remained free of disease 26 months after surgery.     

Haemangiopericytoma of the nasal cavity

Haemangiopericytoma of nose and paranasal sinuses is relatively uncommon tumour. It occurs in adults in sixth and seventh decades of life. In view of paucity of intranasal haemangiopericytoma old in Indian literature and young age of patient, we are reporting one case in 28-year-old female who presented with recurrent, profuse epistaxis.     

Training model for nasal packing

A model is described for practising packing of the nose with ribbon gauze in the treatment of epistaxis. The model was constructed from accurate casts of a cadaveric nasal cavity. The value of the model as a practical teaching aid is shown by a trial on a group of 15 accident and emergency (A&E) doctors. After training on the model, there was a significant improvement in the confidence of the doctors to pack a nose, the amount of gauze packed and the visual appearance of the pack. Use of the model should raise the generally poor standard of nasal packing by doctors working in A&E departments.     

Children's perception of nasal resonance

The purpose of this study was to investigate children's perception of nasal resonance in other children. A total of 120 elementary-school-aged children listened to four female children's voices with normal resonance to severe hypernasality and responded to a total of 20 questions. All children responded negatively to severe hypernasality in other children. The findings indicate that hypernasality warrants correction.     

Budesonide and nasal histamine challenge

The possible mode of action of the lately demonstrated steroid effect on the immediate type allergic reaction was investigated. The influence of a topical steroid, budesonide, on the effects that released mediators have on the nasal mucosa was also studied. A nasal histamine challenge study was performed in a double-blind, cross-over fashion, a 1-week pretreatment with budesonide or placebo preceding the challenge. Symptoms were recorded by means of symptom score as well as objectively via rhinomanometry. In contrast to a previous allergen challenge study, the steroid was found to have minimal effect on the histamine-induced nasal symptoms. It is therefore concluded that other modes of steroid action must also be involved in the steroid effect on the immediate type allergic reaction.     

Characterization of nasal airflow

Nasal airflow and trans-nasal pressure difference was measured by active anterior rhinomanometry in 24 subjects. An analysis was undertaken to determine the 'goodness of fit' of two models used to characterize nasal airflow, one model by Broms and the other by O'Neill and Tolley. A judicious approach to choice of fit criterion led to the conclusion that the latter model provided a more accurate characterization of nasal airflow. Additionally this model may be useful to quantify alar valve stiffness. A portable computerized system incorporating the use of the model has been developed and is currently in use.     

Prenatal sonographic diagnosis of nasal malformations

OBJECTIVE: To induce tumor regression with immunotherapy and to characterize the histology. SETTING: National Institute of Cancerology, Mexico City, Mexico. PATIENTS: Thirteen patients with advanced squamous cell carcinoma of the head and neck region. INTERVENTION: A 21-day cycle of preoperative immunotherapy, including a single intravenous infusion of low-dose cyclophosphamide (300 mg/M2), 10 daily perilymphatic injections of a natural cytokine mixture (approximately 150 units interleukin-2 equivalence by enzyme-linked immunosorbent assay), daily oral indomethacin, and daily oral zinc with multivitamins. OUTCOME MEASURES: Pretreatment biopsies were performed to confirm the diagnosis and to characterize the lesion by standard pathologic criteria, including the degree of tumor-associated lymphocytes. Clinical responses were assessed at surgery, and the specimen was analyzed with respect to changes in tumor morphology and lymphoid and inflammatory infiltration (T and B lymphocytes, plasma cells, macrophages, granulocytes, and giant cells). The presurgical and postsurgical characteristics were ascribed percentages based on a representative section. RESULTS: Prior to treatment, on average the biopsies demonstrated 77% solid tumor with 14% stroma and 9% sparse infiltration of lymphocytes. After treatment, one patient had a complete clinical response and showed only residual inflammatory cells and fibrosis. One patient had no clinical or histologic response. Of the remaining 11 patients, 4 had partial, 6 had minor, and 1 had no response. Tumors were reduced an average of 41% (16% solid and 25% fragmented) and lymphoid infiltration increased to 45% without change in residual stroma. CONCLUSIONS: The pathologic changes viewed in the context of the clinical findings indicate that this immunotherapy protocol induces immune regression of the tumor, mediated predominantly by T and B lymphocytes, and thus elicits a tumor-specific immune reaction.     

Comparison of nasal prongs with nasal catheters in the delivery of oxygen to children with hypoxia

Efficient, inexpensive, and safe methods of oxygen delivery are needed for children with severe pneumonia in developing countries. The objective of this study was to estimate the frequency of complications when nasal catheters or nasal prongs are used to delivery oxygen. Ninety-nine children between 2 weeks and 5 years of age with hypoxia were randomized to receive oxygen via nasal catheter (49 children) or nasal prongs (50 children). There was no difference in the incidence of hypoxaemic episodes or in the oxygen flow rates between the two groups. Mucus production was more of a problem in the catheter group. Nasal blockage, intolerance to the method of administration, and nursing effort were generally higher amongst the catheter group, but these differences were not significant, except for nursing effort, when all age groups were analysed together.     

Aminopeptidase activity in human nasal mucosa

BACKGROUND: Aminopeptidases activate bradykinin and degrade many inflammatory peptides. OBJECTIVE: The objective of this study was to identify the types of aminopeptidase activities in human nasal mucosa. METHODS: Human nasal mucosa was homogenized (n = 12), and cytoplasmic (S2) and membrane-rich (P2) fractions were obtained. Several aminopeptidase (Ap) activities were defined by (1) substrate specificity with leucine-enkephalin (leu-Ap) and alanine-nitroanilide (ala-Ap), (2) inhibitor studies with puromycin and bestatin, (3) enzyme activity histochemistry (zymography), (4) immunohistochemistry, and (5) gel electrophoresis. Human volunteers had methacholine, histamine, and allergen nasal provocations to determine the mechanisms controlling nasal aminopeptidase secretion in vivo. RESULTS: P2 was the largest reservoir of puromycin-resistant aminopeptidase activity (630 pmol leu-enk/min/mg protein). S2 contained 32 pmol leu-enk/min/mg activity, with 80% representing puromycin-resistant activity and 20% puromycin-sensitive aminopeptidase (PS-Ap). Ala-Ap was detected in both P2 and S2 fractions and was localized by zymography to epithelial and gland cells. Anti-rat brain-soluble PS-Ap IgG detected immunoreactive material in epithelium, glands, and endothelium. In nasal provocation studies, leu-AP correlated with glandular exocytosis but not vascular leak. CONCLUSIONS: The predominant aminopeptidase in human nasal epithelial and submucosal gland cells was membrane-bound puromycin-resistant aminopeptidase. A novel soluble puromycin-resistant aminopeptidase and lower amounts of soluble PS-Ap were also detected.