[Results after erbium:YAG-laser stapedotomy]

BACKGROUND

The analysis of postoperative results after Erbium : YAG-Laser stapedotomy in patients with otosclerosis.

METHODS

For all operations the microscope-integrated Erbium : YAG-Laser Twin ER (Zeiss, Oberkochen) was used by different surgeons. Data of 53 patients who were operated on between October 1993 and May 1999 were analysed. The mean follow-up time was 17 months. Postoperative bone-conduction and air-conduction thresholds and the presence of postoperative tinnitus and vertigo were analysed. The data were analysed according to the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (1994).

RESULTS

In 49 patients unchanged preoperative minus postoperative pure tone bone conduction averages at 1, 2, and 4 kHz were observed. In 4 patients a slight deterioration between 10 and 20 dB was seen. In 2 patients a new postoperative tinnitus was observed. No patient suffered from vertigo at the time of evaluation. In 22 patients the postoperative air-bone gap was between 0 and 10 dB, in 25 patients between 11 and 20 dB, and in 6 patients between 21 and 30 dB. No patient had a postoperative air-bone gap of more than 30 dB.

CONCLUSIONS

The Erbium : YAG-Laser stapedotomy is a safe technique. Good postoperative hearing results may be achieved in patients with otosclerosis.

The relationship between water vapour saturation of inhaled air and nasal patency

The nasal cavity volume and the temperature of the nasal mucosa are considered to be the most important predictors of nasal conditioning. The aim of this study was to assess the relationship between the intranasal degree of water vapour saturation of inhaled air and nasal patency. Intranasal humidity values at different locations within the nasal cavity of 15 healthy subjects were compared to nasal airway resistance detected by active anterior rhinomanometry (AAR). Repeated measurements were carried out during one day to obtain varying nasal cavity volumes due to the nasal cycle. The end-inspiratory humidity data were obtained with a miniaturised capacitive humidity sensor at defined detection sites within the anterior nasal segment without interruption of nasal breathing. Measurements were carried out at four different times during one day. The degree of water vapour saturation did not correlate with the values of the AAR at any intranasal detection site and time of detection during one day. The study supports the view that there is no correlation between the degree of water vapour saturation within the anterior nasal segment and the nasal resistance during the nasal cycle over the day. Although nasal patency varies because of the nasal cycle, the changes of nasal cavity volume due to the nasal cycle do not seem to influence the degree of water vapour saturation of the inspiratory air.

Prevention of pancreatic fistula with a new synthetic, absorbable sealant: evaluation in a dog model

BACKGROUND

Pancreatic fistula complicates up to 15% to 25% of pancreatic resections, especially with soft, normal pancreas, and is most common after distal pancreatectomy. A new synthetic, absorbable hydrogel sealant has recently been developed and tested for sealing of human aorta, bronchi, and dura; it is FDA approved as a lung sealant in humans. Our objective was to test the efficacy of the sealant in preventing pancreatic leaks in a dog model of distal pancreatectomy.

STUDY DESIGN

Ten dogs underwent bilateral distal pancreatectomy under general anesthesia. Animals were randomized to receive application of the sealant to the pancreatic stumps (n = 5) or no treatment (n = 5). The transected pancreatic duct was not ligated, and the end of the pancreas was neither oversewn nor stapled; closed-suction drains were placed in proximity to the pancreatic stumps before abdominal closure. All animals received normal chow starting on the second postoperative day. Drainage was collected for volume and amylase determination twice daily for 14 days, after which the animals were sacrificed. Pancreatic tissue was collected from the area of transection and was formalin fixed for histopathology.

RESULTS

There was no perioperative mortality. Fluid recovered from closed-suction drains in all animals was uniformly amylase-rich. Over the 14-day study period, daily volume of pancreatic drainage was significantly different between control animals and animals treated with sealant (p < 0.001). By postoperative day 6, the total mean pancreatic drainage in dogs treated with sealant was 25 +/- 5 mL/drain (versus 91 +/- 26 mL/drain in untreated dogs; p < 0.05). This is the point at which we remove the drains in our clinical practice. Examination at 14 days revealed intact sealant at the pancreatic stumps in the treatment group, and histopathology showed a characteristic benign histiocyte reaction to the sealant but no other qualitative differences in the degree of inflammation between control and treatment animals. There were no undrained collections or abscesses.

CONCLUSIONS

A new synthetic hydrogel sealant prevents the formation of significant pancreatic fistulae after distal pancreatectomy in the dog and may be suitable for clinical application.

Evaluation of morphology and microcirculation of the pancreas by ex vivo and in vivo reflectance confocal microscopy

BACKGROUND

Near-infrared reflectance confocal microscopy (CM) provides non-invasive real-time images of thin virtual horizontal tissue sections with high resolution and contrast.

AIM

Aim of the study was to characterize morphology, microcirculation and leukocyte-endothelial interaction (LEI) in normal pancreas by in vivo and ex vivo CM.

METHODS

For CM we used water immersion objective lenses of high numerical aperture and near-infrared wavelengths. Experimentally measured lateral optical resolution is 0.5-1 micron and the axial resolution is 3-5 microns. The maximum depth of resolution was 300-400 microns. For ex vivo imaging, freshly excised pancreatic tissue from rats was studied by reflectance CM and conventional histopathology. For in vivo CM, the pancreatic head was exteriorized on a specially constructed stage for imaging the microcirculation and LEI. Images were obtained in real time at rates of 30 frames/s and later analyzed off-line to evaluate LEI and functional capillary density (FCD).

RESULTS

CM allowed high resolution visualization of normal pancreas acinar cells, ducts, islets, capillaries and LEI in postcapillary venules. Histological images and optical sections from ex vivo CM can be correlated. Cellular morphology is better analyzed by conventional histology, but angioarchitecture and connective tissue structure are better evaluated by CM. FCD (265.7 +/- 16.6 cm-1) and LEI (rolling leukocytes 5.3 +/- 1.6/100 microns/sticking leukocytes 1.5 +/- 0.9/100 microns) were evaluated by in vivo CM in the normal pancreas.

CONCLUSIONS

CM findings in tissues ex vivo correlate with those of classical histology but add informative details of connective tissue structure and angioarchitecture. Potential future applications for in vivo CM include real-time analysis of microcirculation, leukocyte-endothelial interaction and angiostructure in inflammatory and malignant pancreatic diseases.

Site-specific therapeutic effects of protease inhibitors: effect of route of administration in experimental pancreatitis

Inappropriate local and systemic activation of trypsin arising from trypsinogen mediates key steps in the pathogenesis of acute pancreatitis. Trypsin presumably causes direct injury to cells, but also activates other proteases and causes secondary effects such as inducing the expression of adhesion molecules on endothelium and leukocytes, and stimulating leukocytes to secrete cytokines, tissue-damaging enzymes, oxygen radicals and matrix metalloproteinases. Protease inhibition interferes with this cascade of events. Here we review experimental studies on protease inhibition and their potential application and report our findings of site-specific therapeutic effects of the novel protease inhibitor nafamostat (FUT-175) in experimental acute pancreatitis.

[Sense of smell before and after functional esthetic rhinoplasty]

BACKGROUND

The aim of the present study was to determine possible changes in olfactory threshold after functional and esthetic nasal operations and to evaluate whether these changes were recognized by the patients.

METHODS

The study included 41 patients before and after nasal surgery (septoplasty, septorhinoplasty). Nasal airway resistance, olfactory thresholds, and subjective symptom scores were evaluated and compared pre- and postoperatively. The mean follow-up was 5.4 months. Olfactory performance was assessed using the Sniffin' Sticks.

RESULTS AND CONCLUSIONS

The postoperative values in the screening test for olfactory sensitivity were not significantly different from those before nasal surgery. Nasal ventilation was improved postoperatively in all patients, assessed by determination of nasal airway resistance and subjective symptom scores. Besides an increase in nasal ventilation, functional and esthetic nasal operations can lead to improvement of olfactory function. The rarely seen postoperative increase in olfactory threshold does not seem to be subjectively recognizable by the patients.

Nasal mucosal temperature during respiration

One of the most important functions of the nose is heating the inspiratory air. The aim of the present study was to measure nasal mucosal temperature at defined intranasal sites during respiration, without interruption of nasal breathing. A total of 15 healthy volunteers was included in the study. A miniaturized thermocouple was used for continuous detection of the septal mucosal temperature in the nasal vestibule, the nasal valve area, the anterior turbinate area and the nasopharynx during respiration. The highest temperature values were measured at the end of expiration, the lowest values at the end of inspiration with a statistically significant difference (P < 0.005). Mean mucosal temperature ranged from 30.2 +/- 1.7 degrees C to 34.4 +/- 1.1 degrees C. Statistically there were significant differences between the detection sites during inspiration and expiration (P < 0.05). In our study, the temperature values of the nasal mucosa depend on the intranasal detection site and the respiratory cycle. We therefore conclude that whenever data of nasal mucosal temperature are published, it is absolutely essential to describe the precise site of detection and to give information about the time of detection in the respiratory cycle.

Perioperative matrix metalloproteinase inhibition therapy does not impair wound or anastomotic healing

Matrix metalloproteinases (MMPs) catalyze the degradation of collagen and extracellular matrix. They play a role in pathologic states including malignancy, in which they facilitate invasion and metastasis. MMP inhibition has been shown to block neoplastic invasion and improve survival in animal models of malignancy. Concern about the effects of MMP inhibitors on wound and anastomotic healing may limit their potential use in the perioperative period to prevent local and systemic showering of cancer cells from surgical manipulation. We sought to assess the safety of perioperative administration of an MMP inhibitor (BB-94) with respect to skin and bowel healing in a rat model. Absorption of BB-94 was confirmed through high-pressure liquid chromatography and mass spectroscopy of sera from treated animals. Bowel bursting pressure in all animals increased almost 10-fold between 4 and 14 days. Two-way analysis of variance showed no significant difference in bowel bursting pressure between control and treatment animals over time. There was a significant increase in the collagen content of skin specimens of all animals combined between 4 and 28 days. Similarly, all animals showed an increase in bowel collagen between 4 and 28 days. There was no significant difference in skin or bowel collagen concentrations between control and treatment animals over time. Perioperative treatment with MMP inhibition does not impair wound or enteric healing in a rat model of laparotomy and small bowel resection. MMP inhibitors are safe for use as adjuvant therapy after resection for cancer.

Safety of the erbium:yttrium-aluminum-garnet laser in stapes surgery in otosclerosis

OBJECTIVE

The purpose of this study was to present early and late bone-conduction hearing thresholds and data about cochlear and vestibular disturbances in patients after erbium:yttrium-aluminum-garnet (Er:YAG) laser stapedotomy in otosclerosis.

STUDY DESIGN

The study design was a retrospective study.

SETTING

The study was conducted at an academic tertiary referral center.

PATIENTS

In this study, audiologic data of 117 patients undergoing Er:YAG laser-assisted stapedotomy for otosclerosis between 1993 and 1999 were included.

MAIN OUTCOME MEASURES

The preoperative minus 2 postoperative (early, 1-3 days; late, at least 6 weeks) average pure-tone bone-conduction thresholds at 1, 2, and 4 kHz and 0.5, 1, 2, and 3 kHz were calculated. The postoperative appearance of nystagmus, vertigo, and tinnitus was analyzed.

RESULTS

A total of 91 of 117 patients showed unchanged preoperative minus postoperative pure-tone bone-conduction averages at 1, 2, and 4 kHz in the late postoperative measurement. A slight deterioration was observed in 8 of 117 patients. Regarding the frequencies 0.5, 1, 2, and 3 kHz, 97 of 117 patients showed unchanged preoperative minus postoperative pure-tone bone-conduction averages. A new transient tinnitus appeared in 37 of 117 patients, and a new persistent tinnitus was found in 3 of 117 patients. Most of the patients had no postoperative dizziness (63/117 patients) and no postoperative nystagmus (109/117 patients).

CONCLUSION

The study did not show significant sensorineural hearing loss at or below 3 kHz. Vestibular and cochlear function has no clinically relevant suppression after Er:YAG laser stapedotomy.

Matrix metalloproteinase-9 promotes neutrophil migration and alveolar capillary leakage in pancreatitis-associated lung injury in the rat

BACKGROUND & AIMS

In pancreatitis-associated lung injury, neutrophils (PMN) access the lung by migration through endothelial basement membranes. We hypothesize that degeneration of the basement membrane by specific PMN-produced matrix metalloproteinases (MMPs) may facilitate this process.

METHODS

Mild or severe pancreatitis was induced in rats and the consequent pulmonary injury characterized. MMP-2 and MMP-9 activity in supernatant of PMN cultures and homogenates of lungs were assessed by zymography and Western blot. Congruence of PMN and MMP expression in lung tissue was evaluated by neutrophil depletion and fluorescent immunohistochemistry (IHC). The contribution of MMPs to PMN transmigration and lung injury was tested with the MMP inhibitor batimastat (BB-94) in vitro (PMN transmigration across matrigel chambers) and in vivo (myeloperoxidase activity and Evans blue in broncho-alveolar lavage fluid).

RESULTS

MMP-9 was highly expressed in lungs and supernatant of neutrophil cultures in severe pancreatitis, and, to a lesser degree, in mild pancreatitis. Lung IHC showed colocalization of MMP-9 and PMN. PMN depletion simultaneously reduced neutrophil infiltration and MMP-9 levels in lung tissue. Trypsin, interleukin 1 beta, and tumor necrosis factor (TNF)-alpha all potently stimulated MMP-9 release from PMN. BB-94 significantly reduced TNF-alpha-induced PMN transmigration across matrigel and ameliorated transendothelial PMN migration and protein leak in severe pancreatitis.

CONCLUSIONS

MMP-9 secretion by PMN can be stimulated by trypsin and proinflammatory cytokines and increases in pancreatitis in proportion to its severity. MMP inhibition reduces PMN transmigration and reduces resultant alveolar-capillary leakage. These findings suggest an important role for MMP-9 from PMN in the pathogenesis of pancreatitis-associated lung injury.

Temperature and humidity profile of the anterior nasal airways of patients with nasal septal perforation

INTRODUCTION

The most frequent symptoms of patients with nasal septal perforations are crusting and bleeding. The aim of this study was to determine the influence of septal perforations on temperature and humidity of the anterior nasal airways.

PATIENTS AND METHODS

Intranasal temperature and humidity were measured in the nasal valve area, the anterior turbinate area and in the nasopharynx during normal respiration. A miniaturized thermocouple and a humidity sensor were used for continuous detection. Ten patients with septal perforations were enclosed into the study. The results were compared to matched healthy control subjects.

RESULTS

There were no significant differences of the temperature and humidity values between the left and right side of the nasal cavity in each study group. At the end of inspiration, nasal air temperature did not differ significantly between the two study groups. The humidity values at the end of inspiration were statistically significantly lower in the patient group.

CONCLUSIONS

Nasal septal perforations seem to be related to lower humidity in the anterior nasal airways during inspiration. Reduced humidity may contribute to crusting as a main symptom.

Intranasal temperature and humidity profile in patients with nasal septal perforation before and after surgical closure

Common complaints of patients with a nasal septal perforation are crusting, dryness and bleeding. As shown previously, intranasal humidity values are significantly lower in patients with a septal perforation compared with healthy volunteers. The aim of this study was to determine the influence of surgical closure of septal perforations on intranasal temperature and humidity, and to evaluate changes in clinical symptoms after surgery. Ten patients with septal perforations were included in the study. Intranasal temperature and humidity were measured at the nasal valve and anterior turbinate areas before and after surgical closure. Clinical symptoms were assessed using a nasal symptom score. The end-inspiratory humidity values were significantly (P < or = 0.05) higher postoperatively than preoperatively. The increase in temperature at the anterior turbinate area was significantly higher postoperatively. The temperature values at the nasal valve area were not significantly different. Recurrent epistaxis and nasal dryness were reduced after surgery. Nasal septal perforations disturb the intranasal temperature and humidity profile. After surgical closure, heating and humidification is improved. This may be responsible for the reduction of frequent complaints such as bleeding and dryness.

Telomerase activity in periampullary tumors correlates with aggressive malignancy

OBJECTIVE

To determine the presence of telomerase activity in a variety of periampullary malignancies and pancreatic diseases and quantify its activity to establish any association with the stage or aggressiveness of malignancy.

SUMMARY BACKGROUND DATA

Progressive shortening of telomeres, repetitive DNA sequences at the ends of chromosomes, plays a role in cell senescence. Telomerase catalyzes conservation of telomeric repeats and may promote cell immortality and hence malignancy. It is absent in normal tissues but upregulated in more than 80% of cancers.

METHODS

Fresh specimens of 62 periampullary tumors were snap-frozen in liquid nitrogen and adjacent tissue was formalin-fixed for histopathology. The telomerase repeat amplification protocol (TRAP) was used to obtain telomerase DNA products. These were separated with gel electrophoresis, stained with SYBR green, and quantified by densitometry. Findings were confirmed with a fluorometric TRAP assay in which fluorescent primers specific for telomerase were selectively amplified in its presence.

RESULTS

Telomerase activity was upregulated in 26 of 33 periampullary malignancies (79%): 17 of 21 pancreatic adenocarcinomas (81%), 2 of 2 cholangiocarcinomas, 2 of 2 duodenal carcinomas, and 5 of 8 ampullary carcinomas (63%). Poorly differentiated periampullary tumors had significantly higher telomerase activity than well-differentiated tumors, and tumors larger than 2 cm had significantly higher telomerase activity than those 2 cm or smaller. Pancreatic ductal adenocarcinomas with lymph node metastases had significantly greater activity than node-negative cancers. Two of 11 intraductal papillary mucinous tumors were positive for telomerase activity, but only in foci of invasive carcinoma. Chronic pancreatitis (n = 7), serous cystadenomas (n = 5), benign mucinous cystic neoplasms (n = 4), neuroendocrine cancer (n = 1), and acinar cell carcinoma (n = 1) had no detectable telomerase activity.

CONCLUSION

Telomerase activity is common in periampullary carcinomas. The magnitude of activity correlates with aggressiveness in pancreatic adenocarcinoma and may prove useful as a molecular index for biologic staging.

Detection of particles within the nasal airways before and after nasal decongestion

Cleansing of the air is one of the most important functions of the nose. The aim of this investigation was to determine the influence of decongestion of the nasal mucosa with xylometazoline on the intranasal particle deposition at different sites of the nasal cavity. During respiration of an aerosol of starch particles, the non-deposited particles in the air were laseroptically detected in 10 healthy volunteers by a transnasally placed suction probe at different locations within the nasal cavity. The anterior nasal segment was the main area of intranasal particle deposition before and after decongestion of the nasal mucosa. Particle deposition after nasal decongestion was not significantly different from the values before application of xylometazoline. Decongestion of the nasal mucosa and increase in nasal cavity diameter seems not to influence particle deposition of inhaled and exhaled air within a short period after onset of the maximal decongestive effect of xylometazoline.

Regional effects of nafamostat, a novel potent protease and complement inhibitor, on severe necrotizing pancreatitis

BACKGROUND

We evaluated the effect of the novel protease inhibitor nafamostat on rat necrotizing pancreatitis through different routes of administration.

METHODS

Three hours after the induction of severe pancreatitis, the rats received intravenous gabexate or intravenous or local mesenteric intra-arterial nafamostat. At 9 hours, ascites and bronchoalveolar lavage fluid were collected for the evaluation of capillary leakage (Evans blue extravasation). Pancreas and lung were excised for histologic features, myeloperoxidase, and trypsinogen activation peptide. Twenty-four hour survival was evaluated.

RESULTS

Only the intravenous infusion of nafamostat significantly reduced myeloperoxidase (11.7 +/- 2.3 vs 18.3 +/- 1.8 mU/mg; P <.05) and capillary leakage in lungs (Evans blue dye, 1.6 +/- 0.3 vs 2.6 +/- 0.3; P <.05). Only intra-arterial infusion of nafamostat significantly diminished capillary peritoneal leakage (Evans blue dye, 3.6 +/- 0.9 vs 9.4 +/- 0.4; P <.01). Typsinogen activation peptide levels were significantly reduced in all groups, but only intra-arterial infusion did so to baseline. Histologic inflammation in the pancreas was most significantly reduced after intra-arterial infusion (0.92 +/- 0.08 vs 2.91 +/- 0.06; P <.05). No form of protease inhibition reduced mortality rates.

CONCLUSIONS

The effects of protease inhibition depend on the route of administration. Nafamostat has maximal effects on the pancreas and peritoneal capillary leakage when delivered by way of local intra-arterial infusion, and shows a greater reduction of lung leukocyte infiltration and capillary leakage by the intravenous route. Nafamostat is more effective than gabexate.

Desmopressin impairs microcirculation in donor pancreas and early graft function after experimental pancreas transplantation

BACKGROUND

Protective effects of desmopressin in brain dead organ donors oppose reports on a hypercoagulatory potential and an increased leukocyte-endothelial interaction (LEI) after application of the drug. The aim was to evaluate the effect of desmopressin on organ donor's pancreas and early graft function.

METHODS

Donor microcirculation was evaluated via intra-vital microscopy (IVM) in 24 BR (di/di) rats with central diabetes insipidus, randomly assigned to groups I (control without desmopressin application), II (single i.v. application, no pretreatment) or group III (single i.v. desmopressin application, s.c. pretreatment for 3 days). Microcirculation in recipients was evaluated 1 hr and 6 hr after syngenic pancreas transplantation. Groups III and I served as organ donors. After IVM specimens were taken for histology and immunohistochemistry.

RESULTS

Desmopressin in II vs. I led to temporarily (30') increased LEI (Sticker 274.3+/-87.7 vs. 76.5+/-31.1/mm2 endothelial surface; P<0.01) and impaired microcirculation (MCEV 0.43+/-0.07 vs. 0.99+/-0.06 mm/s; P<0.01). Repeated application reduced MCEV and increased LEI for up to 12 hr. Histology in I vs. III showed increased inflammation (n.s.), necrosis (P<0.05) and vacuolization (P<0.01). Immunohistochemistry revealed increased endothelial P-selectin 20' after application. 6 hr after reperfusion organs from III showed reduced MCEV and increased LEI (P<0.01).

CONCLUSION

Repeated application of desmopressin impairs graft microcirculation. Perfusion of the pancreas is significantly reduced at the beginning of organ tissue conservation as well as after reperfusion. These disturbances might partly be due to observed endothelial P-selectin expression. Application of desmopressin up to 12 hr prior to organ explantation may impact graft quality.

Leiomyosarcoma of the ethmoidal cells

Leiomyosarcomas of the paranasal sinuses are rare malignant tumors. A case of a 68-year-old female with leiomyosarcoma of the ethmoidal cells is presented. Since half a year she had a stuffed nose on both sides. Preoperatively, several attacks of epistaxis on the right side occurred. CT scans showed a tumor of the ethmoidal cells on the right side. The tumor was completely removed via a functional endoscopic endonasal approach and right sphenoethmoidectomy and maxillary sinus surgery. The operation was followed by a radiotherapy with 72 Gy. Up to 29 months after the operation local recurrence could not be observed. Endonasal tumor resection followed by radiotherapy in a case of leiomyosarcoma without invasion of orbit and skull base can allow tumor control.

[Endonasal temperature and humidity profile after exposure to various climate-controlled inspiratory air]

BACKGROUND AND OBJECTIVE

The nose as the first segment of the upper respiratory tract is exposed to different climatic conditions of the ambient air. The purpose of this study was to determine whether nasal air conditioning of ambient air is influenced by a short-term exposure to air of different climatic conditions.

PATIENTS AND METHODS

Fifteen healthy volunteers were enclosed into the study. A miniaturised humidity sensor and thermocouple was used for detection of humidity and airway temperature at three detection sites within the anterior nasal cavity. Both parameters were measured at the end of inspiration during breathing of ambient air after exposure to cold dry air, "normal" ambient air, and warm humid air for 10 minutes.

RESULTS

The end-inspiratory intranasal humidity during breathing of ambient air increased at all locations within the nose when the temperature and humidity of the exposure condition increased. At the most anterior detection site, the effect of increase in humidity after exposure to the different climatic conditions was the most pronounced. The increase in intranasal temperature had no relation to the different climatic conditions during the short-term exposure.

CONCLUSIONS

The results suggest that nasal humidification in ambient air can be influenced by short-term exposure to air of extreme temperature and humidity prior to breathing of ambient air.

[Rational diagnosis of pediatric pharyngeal abscess]

BACKGROUND

Diagnostic procedures intend to differentiate superficial cervical abscesses from deep abscesses and uncomplicated lymphadenitis. They should provide identification of the causing agent, of the route of infection and of possible underlying diseases. Present techniques for examining pediatric cervical abscesses should be assessed.

METHODS

Currently published data on diagnostic procedures in pediatric neck abscess from National Library of Medicine data files were evaluated. Moreover, clinical findings, diagnostic procedures, therapy and outcome of 47 children with cervical abscess treated from 1992-1996 were retrospectively evaluated.

RESULTS

Studies providing appropriate evidence on the value of various diagnostic procedures in pediatric cervical abscesses were not found. In 47 patients with confirmed cervical abscess treated at our department, clinical examination, erythrocyte sedimentation rate and ultrasound examination of the neck were sufficient to establish the correct diagnosis. Additional investigations such as MRI or CT-scans, chest X-rays, Mendel-Mantoux test, various virus titres and other laboratory examinations were performed only in selected cases. The route of invasion (tonsil, dental or otogeneous) could be identified in 13 children. In 4 children an infected cervical cyst was found.

CONCLUSIONS

Clinical examination, erythrocyte sedimentation rate and sonography are appropriate to establish the diagnosis of pediatric cervical abscess and in accordance with the principles of Managed Care.

Heating of air in the nasal airways in patients with chronic sinus disease before and after sinus surgery

The main goal of this study was to determine the influence of sinus surgery on the heating of inspired air in the nose. Intranasal temperature values of 22 patients with chronic sinus disease were measured after inspiration at different locations in the nasal cavity. Measurements were done before and 6-8 weeks after sinus surgery. The patients were compared to 22 healthy control subjects. Nasal airway temperature did not differ between the two study groups at any location in the nasal cavity. Nasal decongestion was without significant influence on temperature values in the patients and the volunteers. There was no significant difference of nasal airway temperature before and after sinus surgery. Even after sinus surgery the main area of heating of inspired air seemed to be the anterior part of the nose. Sinus surgery in patients with chronic sinus disease does not seem to influence heating of air in the nasal cavity.

[Warming inhaled air in the nose]

BACKGROUND AND OBJECTIVE

The purpose of this study was to determine whether the temperature at the end of inspiration is the same as the temperature a few seconds after breathing stops at the end of inspiration to study if the nasal mucosa are capable of providing heat during a cessation of breathing.

PATIENTS/METHODS

Fifteen healthy volunteers were included in the study. The temperature at the end of inspiration was compared to the temperature obtained 5 s after cessation of breathing at the end of inspiration and at the end of expiration. Intranasal temperature measurements were taken at three locations in the nose with a miniaturized thermocouple.

RESULTS

The temperature increased during cessation of breathing at all locations. The highest temperature differences between the end of inspiration and 5 s later (breathing at rest) could be observed at the nasal valve area. The lowest temperature difference was found in the nasopharynx. At the end of expiration,the temperature decreased only slightly from the nasopharynx to the nasal valve area.

CONCLUSIONS

The anterior part of the nose in particular is capable of heating the inspired air. This is also important for humidification. Heating of inspired air requires special anatomical conditions of the anterior nasal segment.

[Temperature and humidity profile of the paranasal sinuses before and after mucosal decongestion by xylometazolin]

BACKGROUND

One of the most important functions of the nose is to warm and to humidify air before it reaches the lower respiratory tract. Nasal decongestants as one of the most common drugs used in otorhinolaryngology are often associated with the feeling of a "dry nose". The purpose of this study was to determine the short-term influence of xylometazoline on temperature and humidity in the nasal airways.

METHODS

15 healthy volunteers were enclosed into the study. A miniaturised humidity sensor and thermocouple was used for detection of humidity and airway temperature in the nasal vestibule, at the nasal valve area and in the nasopharynx at the end of inspiration. Measurements were done before and after topical application of xylometazoline.

RESULTS

Temperature and relative humidity increase from the anterior parts of the nose to the nasopharynx at the end of inspiration. The temperature and humidity values after nasal decongestion are not significantly different from the values before application of xylometazoline. As a tendency temperature and humidity values after nasal decongestion are even somewhat higher at the nasal valve area compared to the values before application of xylometazoline.

CONCLUSIONS

Widening of the nasal airways by mucosal decongestion did not lead to a significant change of the nasal temperature and humidity profile 20-30 min after application of xylometazoline. The use of xylometazoline seems not to influence humidifying and heating of inspired air within a short period after onset of the maximal decongestive effect of xylometazoline.

Humidity and temperature profile in the nasal cavity

OBJECTIVES/HYPOTHESIS

Adequate air conditioning in the nasal airways is mandatory for respiration and gas exchange in the lower respiratory tract. The aim of the present study was to measure relative humidity and temperature in the airstream at different sites within the nasal cavity for mapping of relative humidity and temperature in the upper airways.

STUDY DESIGN

Intranasal relative humidity and temperature of 23 volunteers was measured during respiration at different locations in the nasal cavity.

METHODS

The end-inspiratory temperature and humidity data, obtained with a miniaturized thermocouple and a capacitive humidity sensor, were determined.

RESULTS

A high increase of humidity and temperature at the end of inspiration, in relation to the environmental conditions, was found in the anterior nasal segment. The further increase of both parameters between turbinate area and nasopharynx was less pronounced in spite of the longer distance.

CONCLUSIONS

The anterior part of the nasal cavity contributes within a short nasal passage to air conditioning of inspired air.

Detection of particles within the nasal airways during respiration

This study introduces a new experimental setup for particle detection within the nasal airways and describes intranasal deposition of particles at various regions of the nasal cavity and the nasopharynx. During respiration of an aerosol of starch particles the nondeposited particles in the air were detected in 11 volunteers by a transnasally placed suction probe at numerous sites of the nasal cavity and nasopharynx. Another, identical suction probe measured the initial number of inhaled particles at the nostril. The two suction probes were connected to two identical laser particle counters and allowed calculation of particle deposition. Particles 1-3 microm in size were deposited to about 60% within the entire nasal cavity, whereas most of the particles 4-30 microm in size were deposited within the entire nasal cavity. Between 80% and 90% of the particles retained in the nasal cavity were deposited at the anterior nasal segment. Studies on deposition of various drugs within the nasal cavity using this experimental set-up are conceivable.

Perioperative glucocorticoid treatment does not influence early post-laser stapedotomy hearing thresholds

OBJECTIVE

The aim of this study was to evaluate the efficiency of prophylactic perioperative glucocorticoid treatment during stapes surgery in preventing damage to the inner ear and reducing the frequency of early postoperative complications.

STUDY DESIGN

A prospective, randomized, unblinded study design was selected.

SETTING

The study was conducted at an academic tertiary referral center.

PATIENTS

Ninety-five consecutive patients undergoing erbium:YAG laser-assisted stapedotomy for otosclerosis between 1996 and 1999 were included.

MAIN OUTCOME MEASURES

The preoperative minus postoperative (1-4 days and at least 6 weeks) average pure-tone bone conduction thresholds at 1, 2, and 4 kHz were compared in the prednisolone and control groups by the Mann-Whitney U Test. In addition, the occurrences of sensorineural hearing loss of >10 dB, nystagmus, vertigo, and tinnitus were counted and evaluated by use of the Freeman-Halton or Fisher's exact test, respectively.

RESULTS

Prophylactic perioperative prednisolone treatment was not able to improve the early postoperative average bone conduction thresholds or reduce the frequency of early sensorineural hearing loss (p > 0.5). The patients who received perioperative prednisolone treatment experienced postoperative vertigo more frequently than did the control patients (p < 0.05).

CONCLUSION

Perioperative cortisone prophylaxis for prevention of inner ear damage during stapes surgery is ineffective and is associated with increased postoperative patient discomfort.

Rhinolith of the nasal septum

We report an unusual case of rhinolith in the nasal septum in an 11-year-old girl. The rhinolith was detected on X-radiographs made for the planning of an orthodontic treatment. There were no symptoms like nasal obstruction, chronic infection or epistaxis in the young patient. The histopathologic examination after surgical removal showed hyaline cartilage, local fibrosis and pronounced hemosiderosis, indicating possible prior bleeding. Therefore, an endogenic etiology of the intraseptal rhinolith, e.g. a prior trauma of the nasal septum, is assumed. A review of the literature is included.

Temperature profile in the nasal cavity

OBJECTIVES/HYPOTHESIS

Inspired air is heated and moistened as it passes the nasal cavity. The temperature increase should be similar to a heated tube model, depending on the airflow.

STUDY DESIGN

Intranasal temperature values of 50 volunteers were measured after inspiration at different locations: nasal vestibule, nasal valve area, anterior to the head of the middle turbinate, and the nasopharynx. Temperature values were related to nasal airway resistance data.

METHODS

Intranasal temperature measurements were made with a miniaturized thermocouple. Nasal airway resistance was detected by active anterior rhinomanometry.

RESULTS

A logarithmic increase of air temperature from the anterior segment of the nose to the posterior part was noted. In the nasopharynx temperature was approximately 34 degrees C. The highest increase in temperature was observed in the nasal valve area.

CONCLUSIONS

The temperature increase of ambient air in the nasal airways can be compared with a logarithmic curve of the heating of air passing a heated tube. As the heating of air is important for water transport, the space between the nasal valve and the middle turbinate is of special functional importance. No correlation to the results of rhinomanometry was found.

[Spontaneous kidney rupture after delivery due to an urothelial carcinoma]

The case of a spontaneous kidney rupture due to an urothelial carcinoma one week after delivery is presented. Diagnosis was made during operation. In comparison to the carcinoma, which is diagnosed and treated in time, the prognosis is poor. The patient deserved continuous gynecological follow-up and showed the classic symptoms of an urothelial carcinoma for six months. In spite of regular sonographic controls during pregnancy the tumor was not diagnosed. Diagnosis and management of renal carcinomas during pregnancy are discussed.

Total, subtotal, and partial surgical removal of cervicofacial lymphangiomas

OBJECTIVES

To compare different surgical interventions for the treatment of extensive cervicofacial lymphangiomas and to define the minimal extent of surgery necessary to control disease.

DESIGN

Retrospective study. Mean +/- SD follow-up was 31+/-4 months after surgery. Surgical procedures were grouped as follows: (1) total removal, (2) subtotal removal (all cystic structures removed, small plaques of cyst walls left attached to vital structures), (3) partial removal (major cysts removed, some partially resected cystic structures left in place), and (4) incision and aspiration with subsequent compression bandage. Control of disease was defined as no recurrent or residual tumor or as recurrent or residual tumor less than 10% of initial tumor size without evidence of growth on several postoperative examinations and without clinical symptoms or aesthetic disfigurement.

PATIENTS

Twenty-one patients with cervicofacial lymphangiomas (>3 cm in maximum diameter) without thoracic involvement were evaluated. Fifteen patients were 6 years or younger and 6 were older than 6 years. No surgery was yet performed in 3 patients, for a total of 24 surgical interventions in 18 patients.

SETTING

Hospitalized care in 2 referral centers.

RESULTS

After total removal, disease was controlled in 5 of 5 cases; after subtotal removal, in 8 of 9 cases; after partial removal, in 1 of 7 cases; and after incision and aspiration with subsequent compression bandage, in 0 of 3 cases. Two complications were encountered-1 fully reversible paresis of the marginal branch of the facial nerve and 1 secondary healing.

CONCLUSIONS

Surgical removal of cervicofacial lymphangiomas is a safe treatment modality. Disease control can be achieved if all cystic structures are removed. Small plaques of cyst walls attached to vital structures may be left in place. If small cystic extensions of lymphangiomas are only opened and left in place or if lymphangiomas are only drained following compression bandage, symptomatic residual tumor or recurrence is frequent.

cDNA cloning, recombinant expression and characterization of polypetides with exceptional DNA affinity

Polypeptides remaining tightly associated with isolated genomic DNA are of interest with respect to their potential involvement in the topological organization and/or function of genomic DNA. Such residual DNA-polypeptide complexes were used for raising monoclonal antibodies by in vitro immunization. Screening of a murine lambdagt11 cDNA library with these antibodies released a positive cDNA (MC1D) encoding a 16 kDa polypeptide. The cloned homologous human cDNA (HC1D) was identified in the dbest data base by partial sequence comparison, and it was sequenced full length. The cDNA-derived amino acid sequences comprise nuclear location signals but none of the known DNA-binding motifs. However, the recombinantly expressed proteins show in vitro DNA binding affinities. A polyclonal antiserum to the recombinant MC1D protein immunostains sub-nuclear structures, and it detects a residual 16 kDa polypeptide on western blots of DNA digests. These results support the conclusion that the cloned cDNAs reflect mRNAs encoding one of the chemically-resistant polypeptides which can be detected in isolated genomic DNA by sensitive techniques, e.g. by125Iodine labeling and SDS-PAGE.

Mathematic model to estimate change in burn scar length required for joint range of motion

Burn scar contracture results from an insufficient amount of extensible tissue to permit complete range of motion. The purpose of this study was to develop a mathematic model to estimate additional tissue length required for full range of motion in the presence of a scar contracture. Seven areas with a known predilection for burn scar contracture were assessed. Twenty-five volunteers with normal range of motion had the length of their limbs measured at predetermined angles. Changes in limb length through range of motion were documented. On the basis of these changes, a mathematic model was developed to estimate the additional amount of tissue length required to complete range of motion for each area. This information may be useful to determine burn patient rehabilitation potential or need for reconstructive surgery.