Sphenopalatine Ganglion Stimulation to Augment Cerebral Blood Flow

Background and Purpose—

Many patients with acute ischemic stroke are not eligible for thrombolysis or mechanical reperfusion therapies due to contraindications, inaccessible vascular occlusions, late presentation, or large infarct core. Sphenopalatine ganglion (SPG) stimulation to enhance collateral flow and stabilize the blood-brain barrier offers an alternative, potentially more widely deliverable, therapy.

Methods—

In a randomized, sham-controlled, double-masked trial at 41 centers in 7 countries, patients with anterior circulation ischemic stroke not treated with reperfusion therapies within 24 hours of onset were randomly allocated to active SPG stimulation or sham control. The primary efficacy outcome was improvement beyond expectations on the modified Rankin Scale of global disability at 90 days (sliding dichotomy), assessed in the modified intention-to-treat population. The initial planned sample size was 660 patients, but the trial was stopped early when technical improvements in device placement occurred, so that analysis of accumulated experience could be conducted to inform a successor trial.

Results—

Among 303 enrolled patients, 253 received at least one active SPG or sham stimulation, constituting the modified intention-to-treat population (153 SPG stimulation and 100 sham control). Age was median 73 years (interquartile range, 64–79), 52.6% were female, deficit severity on the National Institutes of Health Stroke Scale was median 11 (interquartile range, 9–15), and time from last known well median 18.6 hours (interquartile range, 14.5–22.5). For the primary outcome, improved 3-month disability beyond expectations, rates in the SPG versus sham treatment groups were 49.7% versus 40.0%; odds ratio, 1.48 (95% CI, 0.89–2.47); P =0.13. A significant treatment interaction with stroke location (cortical versus noncortical) was noted, P =0.04. In the 87 patients with confirmed cortical involvement, rates of improvement beyond expectations were 50.0% versus 27.0%; odds ratio, 2.70 (95% CI, 1.08–6.73); P =0.03. Similar response patterns were observed for all prespecified secondary efficacy outcomes. No differences in mortality or serious adverse event safety end points were observed.

Conclusions—

SPG stimulation within 24 hours of onset is safe in acute ischemic stroke. SPG stimulation was not shown to statistically significantly improve 3-month disability above expectations, though favorable outcomes were nominally higher with SPG stimulation. Beneficial effects may distinctively be conferred in patients with confirmed cortical involvement. The results of this study need to be confirmed in a larger pivotal study.

Clinical Trial Registration—

URL: https://www.clinicaltrials.gov . Unique identifier: NCT03767192.

Ocena jakości życia przed i po septorynoplastyce metodą otwartą przy użyciu ankiety WHOQOL-BREF

Abstract Introduction: The aim of the study was to assess the influence of rhinoplasty on the quality of different aspects of life. The study group included 79 patients with congenital or posttraumatic nasal deformities (38 males, 41 females) aged from 17 to 49 years (mean age 20 years) with open technique septorhinoplasty. Materials and Methods: The quality of life was assessed before and 3 months after surgery, with the WHOQOL-BREF questionnaire. Furthermore, other patient data including demographic data, other surgeries and comorbidities were also registered. Completion of 71 preoperative and 70 postoperative questionnaires was accomplished. The results showed statistically significant differences within the quality of life in all domains. Discussion and conclusion: Based on the conducted studies and after analysis of available literature, it may be concluded that functional and plastic surgeries including septorhinoplasty have an influence on the quality of life.To control post-operative results, tools evaluating this aspect should be used.

[Comparison of dissolvable sinus dressings in functional endoscopic sinus surgery]

OBJECTIVES

Nasal packing is commonly practiced in postoperative care after nose and sinus surgery, not only for haemostasis but also as internal stabilisation and synechia formation control. The aim of our study was to compare the pain level, adhessions and haemostatic properties of Stammberger sinus dressing (SSD) with Dissolvable Sinu-Knit (DSK) and routine nasal packing in latex gloves finger (RNP) after FESS in adult patients.

METHODS

45 patients with bilateral chronic rhinosinusitis (CRS) (totally 90 sides) were recruited into our trial. All patients underwent bilateral FESS without septoplasty. Following completion of surgery, every single nasal cavity side was packed with one of the studied dressing chosen randomly. In 41 sides nasal cavities were packed with Stammberger Sinus Dressing (SSD) in 26 sides packed with Dissolvable Sinu-Knit and 23 sides were filled with routine nasal packing in latex gloves finger (RNP). Haemostatic effect was assessed during the recovery period, pain level was recorded by the patients on a visual analogue scale 24 hours after surgery. Tendency to postoperative middle meatal synechia formations was assessed during control visits in the 1, 2, 4 and 8 week postoperatively.

RESULTS

Three (7.3%) of sides packed with SSD and four (15.3%) packed with DSK had primary postoperative bleeding that required additional packing. Finally 3D patients were packed with RNP. In patients packed with RNP bleeding didn't appear. Mean pain level for SSD was 0.85 (range from 0 to 3) and for DSK 2.1 (range 0 to 5) whereas for RNP was 5.6 (range from 2 to 9). Five (13.1%) of thirty-eight sides with SSD and five (22.7%) of twenty-two sides with DSK had synechia in middle meatus whereas eight (26.6%) of total thirty sides packed with RNP had synechia at any one of the control visits.

CONCLUSION

We found that Rapid Rhino Stammberger Sinus Dressing and Dissolvable Sinu-Knit are associated with very low local pain level and with a good effect in postoperative bleeding and synechia formation control.

[Evaluation of polypectomy-related changes on olfactory function]

AIM

Aim of this study was to evaluate polypectomy-related changes of olfactory function in early postoperative period in comparison to the preoperative situation.

MATERIAL AND METHODS

Olfactory function was assessed in 25 patients of Military Medical Institute using Elsberg-Levy method. Measurements were performed preoperatively and 1 month after polypectomy.

RESULTS

Before the polypectomy measurements revealed higher odor thresholds in 18 patients. Postoperatively, decline of odor thresholds was observed in 14 hyposmic patients.

CONCLUSION

Present data indicates that olfactory function is related to nasal obstruction resulting from nasal polyposis. The study showed that polypectomy can increase olfactory function in patients with nasal polyps. Olfactometry can help to estimate nasal polyps during and after treatment even in early stage.

[Assessment of the correlation between taste and smell functioning]

There are few studies examining relationship between taste and smell. However their clinical unity is more often indicated. Smell perception abnormalities cause modification in taste of food intensity, disabling perception of taste as a consequence of taste's sniffing failure. Thus disturbances of these senses, which often commonly coexist could cause great discomfort in patients, however taste sense is estimated as less important comparing to smell sense. The aim of that study was to compare the taste perception in patients with normal smell function and patients with hyposmia and anosmia. There was analyzed correlation between the patients' subjective estimation of smell and taste senses and results of gustometry and olfactometry examinations.

MATERIAL AND METHOD

there were indicated three groups of patients based on smell examination with usage of Elsberga--Levy'ego olfactometr in Pruszewicz modification. The first group included patients with normosmia, the second--patients with hyposmia or anosmia related to every smell, the third--patients with hyposmia on few smells and normal smell feeling of others. The Bornstein's method gustometry modified by us was performed for all groups. Moreover patients presented their subjective estimation of smell and taste senses. All results were statistically analyzed, taking into consideration results with alpha < or = 0.05.

RESULTS

All (100%) patients with normosmia correctly identified sour, bitter and salty tastes, while only 53% of patients with hyposmia and anosmia got similar results. However 76.5% of patients from the second group subjectively estimated their sense of taste as a normal perception.

CONCLUSIONS

Patients with smell disturbances significantly more often have abnormalities in taste perception than patients with normosmia and their subjective estimation of taste and smell senses is much more different than gustometry and olfactometry results.