bluuebunny/crossref_metadata_2025 huggingface dataset:
Determination of Phosphorus Speciation in Dairy Manure using XRD and XANES Spectroscopy
Authors: Güngör Kerem , Jürgensen Astrid , Karthikeyan K. G.
Published: October 2007

Intensive manure application is an important source of diffuse phosphorus (P) pollution. Phosphorus availability from animal manure is influenced by its chemical speciation. The major objective of this study was to investigate the P speciation in raw and anaerobically digested dairy manure with an emphasis on the calcium (Ca) and magnesium (Mg) phosphate phases. Influent and effluent from an on‐farm digester in Wisconsin were sampled and sieved, and the 25 to 53 μm size fraction was dried for X‐ray powder diffraction (XRD) and P K‐edge X‐ray absorption near edge structure (XANES) analyses. Struvite (MgNH4PO4·6H2O) was identified in both the raw (influent) and anaerobically digested (effluent) manure using XRD. Qualitative analysis of P K‐edge XANES spectra indicated that the Ca orthophosphate phases, except dicalcium phosphate anhydrous (DCPA) or monetite (CaHPO4), were not abundant in dairy manure. Linear combination fitting (LCF) of the P standard compounds showed that 57.0 and 43.0% of P was associated with DCPA and struvite, respectively, in the raw manure. In the anaerobically digested sample, 78.2% of P was present as struvite and 21.8% of P was associated with hydroxylapatite (HAp). The P speciation shifted toward Mg orthophosphates and least soluble Ca orthophosphates following anaerobic digestion. Similarity between the aqueous orthophosphate (aq‐PO4), newberyite (MgHPO4·3H2O), and struvite spectra can cause inaccurate P speciation determination when dairy manure is analyzed solely using P K‐edge XANES spectroscopy; however, XANES can be used in conjunction with XRD to quantify the distribution of inorganic P species in animal manure.
Gaseous Nitrogen Emissions and Forage Nitrogen Uptake on Soils Fertilized with Raw and Treated Swine Manure
Authors: Chantigny Martin H. , Angers Denis A. , Rochette Philippe , Bélanger Gilles , Massé Daniel , Côté Denis
Published: October 2007

Treatments to reduce solids content in liquid manure have been developed, but little information is available on gaseous N emissions and plant N uptake after application of treated liquid swine manure (LSM). We measured crop yield, N uptake, and NH3 and N2O losses after the application of mineral fertilizer (NH4NO3), raw LSM, and LSM that was decanted, filtered, anaerobically digested, or chemically flocculated. The experiment was conducted from 2001 to 2003 on a loam and a sandy loam cropped to timothy (Phleum pratense L.) with annual applications equivalent to 80 kg N ha−1 in spring and 60 kg N ha−1 after the first harvest. Raw LSM resulted in NH3 emissions three to six times larger (P < 0.05) than mineral fertilizer. The LSM treatments reduced NH3 emissions by an average of 25% compared with raw LSM (P < 0.05). The N2O emissions tended to be higher with raw LSM than with mineral fertilizer. The LSM treatments had little effect on N2O emissions, except for anaerobic digestion, which reduced emissions by >50% compared with raw LSM (P < 0.05). Forage yield with raw LSM was >90% of that with mineral fertilizer. The LSM treatments tended to increase forage yield and N uptake relative to raw LSM. We conclude that treated or untreated LSM offers an alternative to mineral fertilizers for forage grass production but care must be taken to minimize NH3 volatilization. Removing solids from LSM by mechanical, chemical, and biological means reduced NH3 losses from LSM applied to perennial grass.
Soil Biogeochemical Characteristics Influenced by Alum Application in a Municipal Wastewater Treatment Wetland
Authors: Malecki‐Brown Lynette M. , White John R. , Reddy K. R.
Published: October 2007

Constructed treatment wetlands are a relatively low‐cost alternative used for tertiary treatment of wastewater. Phosphorus (P) removal capacity of these wetlands may decline, however, as P is released from the accrued organic soils. Little research has been done on methods to restore the treatment capacity of aging constructed wetlands. One possibility is the seasonal addition of alum during periods of low productivity and nutrient removal. Our 3‐mo mesocosm study investigated the effectiveness of alum in immobilizing P during periods of reduced treatment efficiency, as well as the effects on soil biogeochemistry. Eighteen mesocosms were established, triplicate experimental and control units for Typha sp., Schoenoplectus californicus, and submerged aquatic vegetation (SAV) (Najas guadalupensis dominated). Alum was slowly dripped to the water column of the experimental units at a rate of 0.91 g Al m−2 d−1 and water quality parameters were monitored. Soil cores were collected at experiment initiation and completion and sectioned into 0‐ to 5‐ and 5‐ to 10‐cm intervals for characterization. The alum floc remained in the 0‐ to 5‐cm surface soil, however, soil pH and microbial parameters were impacted throughout the upper 10 cm with the lowest pH found in the Typha treatment. Plant type did not impact most biogeochemical parameters; however, data were more variable in the SAV mesocosms. Amorphous Al was greater in the surface soil of alum‐treated mesocosms, inversely correlated with soil pH and microbial biomass P in both soil layers. Microbial activity was also suppressed in the surface soil of alum‐treated mesocosms. This research suggests alum may significantly affect the biogeochemistry of treatment wetlands and needs further investigation.
An Empirical Model of Soil Chemical Properties that Regulate Methane Production in Japanese Rice Paddy Soils
Authors: Cheng Weiguo , Yagi Kazuyuki , Akiyama Hiroko , Nishimura Seiichi , Sudo Shigeto , Fumoto Tamon , Hasegawa Toshihiro , Hartley Anne E. , Megonigal J. Patrick
Published: October 2007

To understand which soil chemical properties are the best predictors of CH4 production in rice paddy soils, a model was developed with empirical data from nine types of rice soils collected around Japan and anaerobically incubated at 30°C for 16 wk in laboratory conditions. After 1, 2, 4, 8, and 16 wk of incubation, CO2, CH4, and Fe(II) were measured to understand soil organic matter decomposition and iron (Fe) reduction. Available N (Nava) was also measured at the end of incubation. The results showed that decomposable C and reducible Fe are two key parameters that regulate soil CH4 production (PCH4). There was a significant relationship between decomposable C and available N (Nava) (r2 = 0.975**). Except for a sandy soil sample, a significant relationship between total Fe (Fetotal) and reducible Fe was found. From this experiment, a simple model of soil CH4 production was developed: PCH4 = 1.593Nava – 2.460Fetotal/1000 (each unit was mg kg−1 soil). After simulated CH4 production by two soil chemical properties as above, there was a significant consistency between model simulation and actual measurement (r2 = 0.831**).
In Situ Soil Water Extraction: A Review
Authors: Weihermüller L. , Siemens J. , Deurer M. , Knoblauch S. , Rupp H. , Göttlein A. , Pütz T.
Published: October 2007

The knowledge of the composition and fluxes of vadose zone water is essential for a wide range of scientific and practical fields, including water‐use management, pesticide registration, fate of xenobiotics, monitoring of disposal from mining and industries, nutrient management of agricultural and forest ecosystems, ecology, and environmental protection. Nowadays, water and solute flow can be monitored using either in situ methods or minimally invasive geophysical measurements. In situ information, however, is necessary to interpret most geophysical data sets and to determine the chemical composition of seepage water. Therefore, we present a comprehensive review of in situ soil water extraction methods to monitor solute concentration, solute transport, and to calculate mass balances in natural soils. We distinguished six different sampling devices: porous cups, porous plates, capillary wicks, pan lysimeters, resin boxes, and lysimeters. For each of the six sampling devices we discuss the basic principles, the advantages and disadvantages, and limits of data acquisition. We also give decision guidance for the selection of the appropriate sampling system. The choice of material is addressed in terms of potential contamination, filtering, and sorption of the target substances. The information provided in this review will support scientists and professionals in optimizing their experimental set‐up for meeting their specific goals.
The Decision Not to Drive During Hypoglycemia in Patients With Type 1 and Type 2 Diabetes According to Hypoglycemia Awareness
Authors: Stork Alexander D.M. , van Haeften Timon W. , Veneman Thiemo F.
Published: October 2007

OBJECTIVE—In recent years, there has been an ongoing discussion on the relationship between diabetes and driving. As driving performance will inevitably decline at lower levels of glycemia, patients’ decisions concerning driving or taking corrective action when hypoglycemia occurs immediately before or during driving seems paramount.

RESEARCH DESIGN AND METHODS—Twenty-four type 1 diabetic patients with normal awareness of hypoglycemia (T1Norm group), 21 type 1 diabetic patients with impaired awareness of hypoglycemia (T1Imp group), and 20 type 2 diabetic patients with normal awareness of hypoglycemia (T2 group) were studied. They were asked whether they felt hypoglycemic and whether they would currently drive during experimental euglycemia (5.0 mmol/l) and hypoglycemia (2.7 mmol/l).

RESULTS—In the T1Norm group, 1 patient (4.2%) decided to drive during hypoglycemia. In the T1Imp group, 9 patients (42.9%) said they would drive in the hypoglycemic condition. In the T2 group, 5 patients (25%) would drive. This was more frequently the case for patients on oral hypoglycemic agents (χ2 = 4.44; P = 0.04). No effect of sex (χ2 = 0.78; P = 0.38) or age (χ2 = 0.22; P = 0.64) was noted.

CONCLUSIONS—Patients with type 1 diabetes and impaired awareness of hypoglycemia frequently decided to drive while hypoglycemic, whereas patients with type 1 diabetes and normal awareness of hypoglycemia appeared to make safe decisions concerning hypoglycemia and driving. Strikingly, patients with type 2 diabetes and normal hypoglycemia awareness frequently made potentially dangerous decisions as well, particularly when using oral hypoglycemic agents. Therefore, early, clear, and consistent education is imperative.
Increases in Central Aortic Impedance Precede Alterations in Arterial Stiffness Measures in Type 1 Diabetes
Authors: Sweitzer Nancy K. , Shenoy Mohan , Stein James H. , Keles Sunduz , Palta Mari , LeCaire Tamara , Mitchell Gary F.
Published: October 2007

OBJECTIVE—Increased pulse pressure has been associated with increased cardiovascular risk in individuals with diabetes. Changes in central aortic properties can increase central pulse pressure and may adversely affect microvascular perfusion and cardiac performance. This study was performed to define early changes in central arterial properties in a group of young individuals with type 1 diabetes.

RESEARCH AND DESIGN METHODS—Seventeen individuals with type 1 diabetes and their nondiabetic control subjects who were participating in the Cardio-Diab Study had arterial stiffness and pulsatile hemodynamics measured with calibrated tonometry and pulsed Doppler. Aortic characteristic impedance (Zc) was calculated from the ratio of change in carotid pressure and aortic flow in early systole. Pulse wave velocity (PWV) was assessed from tonometry and body surface measurements.

RESULTS—Duration of type 1 diabetes was 15.3 ± 0.7 (mean ± SD) years. In type 1 diabetic subjects, central pulse pressure was elevated (45 ± 11 vs. 36 ± 10 mmHg in control subjects, P = 0.02), as was peripheral pulse pressure (54 ± 13 vs. 43 ± 10 mmHg, P = 0.002). Zc was elevated in type 1 diabetes (179 ± 57 vs. 136 ± 42 dynes × s/cm5 in control subjects, P = 0.004), whereas PWV was not different (5.9 ± 0.9 vs. 5.9 ± 0.7 m/s in type 1 diabetic vs. control subjects, respectively; NS). There was a moderate correlation between Zc and urinary albumin excretion (coefficient 0.39, P = 0.02).

CONCLUSIONS—Zc appears to be increased early in type 1 diabetes, before elevation of PWV and is associated with higher pulse pressure, which may contribute to renal microvascular damage in diabetes.
Effectiveness of a Self-Management Intervention in Patients With Screen-Detected Type 2 Diabetes
Authors: Thoolen Bart , De Ridder Denise , Bensing Jozien , Maas Cora , Griffin Simon , Gorter Kees , Rutten Guy
Published: October 2007

OBJECTIVE—To examine the effectiveness of a theory-driven self-management course in reducing cardiovascular risk in patients with screen-detected type 2 diabetes, taking ongoing medical treatment into account.

RESEARCH DESIGN AND METHODS—A total of 196 screen-detected patients, receiving either intensive pharmacological or usual-care treatment since diagnosis (3–33 months previously), were subsequently randomized to a control or intervention condition (self-management course). A 2 × 2 factorial design evaluated the behavioral intervention (self-management course versus control) nested within the medical treatment (intensive versus usualcare), using multilevel regression modeling to analyze changes in patients’ BMI, A1C, blood pressure (BP), and lipid profiles over 12 months, from the start of the 3-month course to 9-month follow-up.

RESULTS—The self-management course significantly reduced BMI (−0.77 kg/m2) and systolic BP (−6.2 mmHg) up until the 9-month follow-up, regardless of medical treatment. However, intensive medical treatment was also independently associated with lower BP, A1C, total cholesterol, and LDL before the course and further improvements in systolic BP (−4.7 mmHg). Patients receiving both intensive medical treatment and the self-management course therefore had the best outcomes.

CONCLUSIONS—This self-management course was effective in achieving sustained reductions in weight and BP, independent of medical treatment. A combination of behavioral and medical interventions is particularly effective in reducing cardiovascular risk in newly diagnosed patients.
Symptoms of Diabetes and Their Association With the Risk and Presence of Diabetes
Authors: Clark Nathaniel G. , Fox Kathleen M. , Grandy Susan ,   for the SHIELD Study Group
Published: October 2007

OBJECTIVE—The American Diabetes Association (ADA) lists seven symptoms of diabetes; however, it is not known how specific these symptoms are for initial diagnosis of type 2 diabetes. The Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) examined prevalence of ADA symptoms and their association with diabetes diagnosis.

RESEARCH DESIGN AND METHODS—SHIELD is a 5-year observational study of individuals with or at risk for diabetes diagnosis. Following an initial screening phase, follow-up questionnaires were mailed to a stratified random sample of individuals (n = 22,001) with type 1 or type 2 diabetes or at high (three to five risk factors) or low (zero to two risk factors) risk for diabetes. Individuals reported whether they experienced each ADA symptom, as well as symptoms unrelated to diabetes.

RESULTS—A total of 15,794 questionnaires were returned (response rate 71.8%). All ADA symptoms were reported more frequently in type 2 diabetes than in low- and high-risk groups (P < 0.0001 for each). Multivariable logistic regression analyses found that each ADA symptom other than irritability was significantly associated with type 2 diabetes, as was erectile/sexual dysfunction. However, 48% of type 1 diabetic and 44% of type 2 diabetic respondents reported no ADA symptom in the previous year.

CONCLUSIONS—Occurrence of ADA symptoms alone may not adequately identify those who should be evaluated for type 2 diabetes. Longitudinal data from SHIELD will evaluate whether combinations of symptoms or addition of other symptoms can better identify individuals for evaluation.
Osteoprotegerin: A Novel Independent Marker for Silent Myocardial Ischemia in Asymptomatic Diabetic Patients
Authors: Avignon Antoine , Sultan Ariane , Piot Christophe , Mariano-Goulart Denis , Thuan dit Dieudonné Jean-François , Cristol Jean Paul , Dupuy Anne Marie
Published: October 2007

OBJECTIVE—We sought to evaluate osteoprotegerin, an inhibitor of osteoclastogenesis involved in atherosclerosis, and other novel risk factors as predictive markers of silent myocardial ischemia (SMI).

RESEARCH DESIGN AND METHODS—A total of 465 consecutive diabetic patients with more than one additional risk factor were evaluated for SMI using stress myocardial perfusion imaging (MPI). We studied the association of SMI (positive stress electrocardiogram and/or abnormal MPI) with osteoprotegerin, other novel risk factors (lipoprotein[a], homocysteine, adiponectin, C-reactive protein, and fibrinogen), and conventional risk factors (total, LDL, and HDL cholesterol and triglycerides).

RESULTS—A total of 92 patients were diagnosed with SMI. Of the six novel markers, osteoprotegerin was the only one associated with SMI; the relative risk (RR) of SMI in patients with osteoprotegerin values above the 75th percentile was 3.19 (95% CI 1.99–5.18; P < 0.001) in comparison with those with osteoprotegerin below the 75th percentile. In univariate analyses, the other plasma markers significantly associated with SMI were higher triglycerides (P = 0.04) and lower HDL cholesterol (P = 0.02). The association of osteoprotegerin with SMI remained significant after correcting for other variables associated with SMI at P < 0.15 in univariate analysis (RR 3.95 [95% CI 2.21–7.06]; P < 0.0001). The association of osteoprotegerin with SMI was observed in male (P < 0.0001) and female (P = 0.03) patients, in type 1 (P = 0.002) and type 2 (P = 0.0004) diabetic patients, in patients with (P = 0.0004) or without (P = 0.03) nephropathy, and in patients without (P < 0.0001) but not with (P = 0.2) peripheral arterial disease.

CONCLUSIONS—Osteoprotegerin measurement, together with other conventional factors, can help to better define the diabetic population with an increased likelihood for SMI.
Changes in Vigorous Physical Activity and Incident Diabetes in Male Runners
Authors: Williams Paul T.
Published: October 2007

OBJECTIVE—We examined the relationship between changes in reported vigorous exercise and self-reported physician-diagnosed diabetes in 25,988 active men.

RESEARCH DESIGN AND METHODS—The dose-response relationship between changes in reported vigorous exercise (running distance, change in kilometers per week) and self-reported physician-diagnosed diabetes was followed prospectively for 7.8 ± 1.8 years (means ± SD).

RESULTS—Logistic regression analyses showed that the log odds for diabetes declined significantly in relation to men's change in running distance (coefficient ± SE: −0.012 ± 0.004, P < 0.01), which remained significant when adjusted for BMI (−0.018 ± 0.003, P < 0.0001). The decline in the log odds for diabetes was related to the distance run at the end of follow-up when adjusted for baseline distance, with (−0.024 ± 0.005, P < 0.0001) or without (−0.027 ± 0.005, P < 0.0001) adjustment for BMI. Baseline distance was unrelated to diabetes incidence when adjusted for the distance at the end of follow-up. Compared with men who ran <8 km/week at the end of follow-up, incidence rates in those who ran ≥8 km/week were 95% lower between 35 and 44 years of age (P < 0.0001), 92% lower between 45 and 54 (P < 0.0001), 87% lower between 55 and 64 (P < 0.0001), and 46% lower between 65 and 75 (P = 0.30). For the subset of 6,208 men who maintained the same running distance during follow-up (±5 km/week), the log odds for diabetes declined with weekly distance run (−0.024 ± 0.010, P = 0.02) but not when adjusted for BMI (−0.005 ± 0.010, P = 0.65).

CONCLUSIONS—Vigorous exercise significantly reduces diabetes incidence, due in part to the prevention of age-related weight gain and in part to other exercise effects.
Fungus Culture of the Nasal Secretion of Chronic Rhinosinusitis Patients: Seasonal Variations in Daegu, Korea
Authors: Shin Seung-Heon , Ye Mi-Kyung , Lee Young-Ho
Published: October 2007

Background

The role of fungi in the pathogenesis of chronic rhinosinusitis (CRS) is being increasingly recognized. The presences of fungal spores are a necessary condition for fungal sinusitis, and fungal spore counts vary widely, both geographically and seasonally. The aim of this study was to characterize fungal seasonal variation in the nasal cavity of CRS patients and to compare it with histologic types of nasal polyps.

Methods

One hundred eight patients with a clinical diagnosis of CRS with polyps were enrolled in this study for 1 year. Nasal secretions were obtained by aspiration and cultured to identify fungi. Nasal polyps were divided into four histologic types: eosinophilic, fibroinflammatory, seromucinous, and atypical.

Results

Positive cultures for fungi were obtained in 60 of 108 (63.0%) CRS patients, and 28 of 45 (62.2%) normal volunteers. Fungus culture rates were higher during summer and fall. Cladosporium, Aspergillus, Alternaria, and Penicilium were frequently isolated from CRS patients and normal volunteers. The most common histologic type was the fibroinflammatory type (60.2%), although in the summer and fall the proportion of the eosinophilic type increased.

Conclusion

Fungi were commonly cultured during a hot and humid environment, during summer and fall, and cultured organism types were found to be seasonal dependent. Histologic types of nasal polyps appear to be associated with fungal culture rate, organism type, and seasonal variations.
Exhaled Inflammatory Markers in Aspirin-Induced Asthma Syndrome
Authors: Carpagnano Giovanna E. , Resta Onofrio , Gelardi Matteo , Spanevello Antonio , Di Gioia Giuseppe , Giliberti Tiziana , Depalo Annarita , Barbaro Maria P. Foschino
Published: October 2007

Background

Interleukin (IL)-4 and IL-6, respectively, markers of neutrophilic and eosinophilic inflammation, were analyzed in nasal and oral exhaled breath condensate to understand the inflammation of upper and lower airways in subjects with aspirin-induced asthma (AIA) syndrome, evaluating possible differences between AIA and the single pathological conditions included in AIA syndrome.

Methods

Twelve patients with AIA, 17 patients with mild asthma (MA), 12 patients with nasal polyposis (NP), 11 patients with mild asthma + nasal polyposis (MA + NP), and 10 healthy subjects (HSs) were enrolled. Nasal and oral exhaled IL-4 and IL-6 were measured by enzyme immunoassay kit.

Results

Higher levels of nasal and oral exhaled IL-4 and IL-6 were observed in AIA compared with MA, NP, MA + NP, and HSs. Moreover, a positive correlation was identified between nasal exhaled IL-4 and IL-6 and, respectively, the number of neutrophils and eosinophils and in nasal scraping.

Conclusion

The concentration of eosinophilic and neutrophilic markers in upper and lower airways of subjects with AIA syndrome is higher compared with HS and subjects with MA, NP, and MA + NP.
Can we Smell without an Olfactory Bulb?
Authors: Rombaux Philippe , Mouraux André , Bertrand Bernard , Duprez Thierry , Hummel Thomas
Published: October 2007

Background

Lack of an olfactory bulb (OB) is typically associated with anosmia.

Methods

We present a patient with subnormal olfactory function in whom the OB could not be detected with magnetic resonance imaging (MRI).

Results

Olfactory function was evaluated on two occasions. Orthonasal olfactory function was assessed with the “Sniffin’ Sticks” test providing a score equivalent to hyposmia. Retronasal olfactory function was studied with “smell powders” indicating a decreased, but not absence of, olfactory function. Importantly, chemosensory event-related potentials were clearly present in response to olfactory and trigeminal stimuli.

Conclusion

This indicates that olfactory function may be present in some subjects even when an OB can not be detected with MRI.
Murine Tracheal and Nasal Septal Epithelium for Air–Liquid Interface Cultures: A Comparative Study
Authors: Woodworth Bradford A. , Antunes Marcelo B. , Bhargave Geeta , Palmer James N. , Cohen Noam A.
Published: October 2007

Background

Air–liquid interface cultures using murine tracheal respiratory epithelium have revolutionized the in vitro study of airway diseases. However, these cultures often are impractical because of the small number of respiratory epithelial cells that can be isolated from the mouse trachea. The ability to study ciliary physiology in vitro is of utmost importance in the research of chronic rhinosinusitis (CRS). Our hypothesis is that the murine nasal septum is a better source of ciliated respiratory epithelium to develop respiratory epithelial air–liquid interface models.

Methods

Nasal septa and tracheas were harvested from 10 BALB/c mice. The nasal septa were harvested by using a simple and straightforward novel technique. Scanning electron microscopy was performed on all specimens. Cell counts of ciliated respiratory epithelial cells were performed at one standard magnification (1535×). Comparative analysis of proximal and distal trachea, midanterior and midposterior nasal septal epithelium, was performed.

Results

Independent cell counts revealed highly significant differences in the proportion of cell populations (p < 0.00001). Ciliated cell counts for the trachea (106.9 ± 28) were an average of 38.7% of the total cell population. Nasal septal ciliated epithelial cells (277.5 ± 16) comprised 90.1% of the total cell population.

Conclusion

To increase the yield of respiratory epithelial cells harvested from mice, we have found that the nasal septum is a far superior source when compared with the trachea. The greater surface area and increased concentration of ciliated epithelial cells has the potential to provide an eightfold increase in epithelial cells for the development of air–liquid interface cultures.
Sinus Fluid Penetration of Oral Clarithromycin and Azithromycin in Patients with Acute Rhinosinusitis
Authors: Margaritis Vasilios K. , Ismailos George S. , Naxakis Stefanos S. , Mastronikolis Nicholas S. , Goumas Panos D.
Published: October 2007

Background

The aim of this study was to investigate the extracellular concentration and the degree of sinus fluid penetration of newer macrolides, within the first 24–48 hours of treatment in patients with acute bacterial rhinosinusitis (ABRS), choosing clarithromycin and azithromycin as model antibiotics. An open, noninterventional pharmacokinetic study was performed at a tertiary teaching hospital.

Methods

In 36 outpatients with ABRS, sinus fluid aspirates and serum samples were collected 2, 4, 6, 8, and 12 hours or 2, 6, 12, and 24 hours after the administration of three doses of oral clarithromycin, 500 mg, twice daily or two doses of oral azithromycin, 500 mg, once daily, respectively. Drug concentrations were determined in both matrices by high-performance liquid chromatography with fluorometric detection, and the pH was estimated for all sinus fluid samples.

Results

The average clarithromycin sinus fluid concentration was found to be significantly higher than the corresponding azithromycin concentration (2.47 mg/L versus 0.65 mg/L), while the extent of the average sinus fluid penetration, expressed by the ratio of drug concentration in tissue versus serum, was similar for both drugs (115 and 120%, respectively).

Conclusion

In patients with ABRS, clarithromycin and azithromycin present adequate penetration into sinus fluid to eradicate erythromycin-sensitive strains of Streptococcus pneumoniae. Considering their comparative in vitro activity, the sinus fluid pH effect, and their sinus fluid penetration profile, we may conclude that among the erythromycin-resistant S. pneumoniae strains, clarithromycin might be advantageous over azithromycin in eradicating some of the low-level resistant strains.
Radiological Correlation between Pneumatization of Frontal Sinus and Height of Fovea Ethmoidalis
Authors: Gumus Cesur , Yildirim Altan
Published: October 2007

Background

We need more data about the variations of skull base to minimize the complications of ethmoidectomy. The aim of this study was to analyze the relationship between the pneumatization of the frontal sinus and height of the fovea ethmoidalis.

Methods

Paranasal coronal computed tomography (CT) scans of 487 sides of 300 patients were evaluated. The presence of the frontal cell and pneumatization of the frontal sinus were studied with respect to the height of the fovea ethmoidalis.

Results

We found a statistically significant correlation between the frontal cell and frontal sinus hyperpneumatization (p = 0.000). We determined that there was a deeper fovea ethmoidalis in the sides that have a frontal cell (p ≤ 0.001) and in the sides that have hyperpneumatization of the frontal sinus (p = 0.000). We also observed flatter fovea ethmoidalis in the sides that have hypopneumatization of the frontal sinus (p ≤ 0.001).

Conclusion

The presence of a frontal cell or hyperpneumatization of the frontal sinus on CT scan should alert the clinician that there may be a deep fovea ethmoidalis.
Septal Cartilage Graft for Nasal Valve Incompetence Associated with Deviated Septum
Authors: Paccoi Paolo , Di Peco Valerio
Published: October 2007

Background

The nasal valve is one of the major factors contributing to nasal airflow obstruction. Physiologically, the nasal valve offers the greatest resistance to nasal airflow and generally functions as an inflow device controlling nasal airflow and resistance. Many patients who have complaints of breathing impairment are affected by alterations of the nasal septum, the turbinates, the columellar base, the vestibule floor, or the lateral wall of the nose but may have associated incompetence of the nasal valve, which is too often undervalued by nasal surgeons. The aim of this study was to propose a relatively easy surgical technique to correct most nasal valve impairments associated with nasal septum deviation whether or not there also is inferior turbinate hypertrophy.

Methods

Between May 2004 and September 2006, 68 patients (26 women and 42 men; mean age, 37 years; range, 16–71 years) underwent primary or secondary functional nasal surgery, because of a nasal respiratory obstruction caused by nasal septal deviation eventually associated with inferior turbinates hypertrophy, and also demonstrated nasal valvular incompetence. A septal cartilage graft was used to correct the valvular incompetence.

Results

On postoperative visits almost all of the patients (with one exception) showed a remarkable improvement in the stiffening of the valvular region and had only minimal depression of the nostril during deep inspiration.

Conclusion

This study indicated that septal grafts were useful in the surgical management of nasal respiratory impairment because of nasal valve incompetence, where there had been flaccid mobile collapse of the ala of the nose associated with septal alterations.
Inverted Papilloma with New Bone Formation: Report of Three Cases
Authors: Unlu H. Halis , Songu Murat , Ovali Gulgun Yılmaz , Nese Nalan
Published: October 2007

Background

An inverted papilloma (IP) is a benign sinonasal tumor of ectodermal origin, which is locally aggressive and destructive, tends to recur if incompletely removed, and has significant malignant potential. On CT scan, the appearance of an IP is variable and nonspecific but most commonly it appears to have soft tissue density. The association of IPs and new bone formation is extremely rare; to the best of our knowledge, only one case has been reported in the literature to date.

Methods

We report three cases with existence of bony mass surrounded by polypoid soft tissue diagnosed as IP histopathologically.

Results

The nature, shape, and location of the bony mass were not in concordance with trapped bone, with tumoral calcifications, or with osteoma.

Conclusion

We propose that with regard to the three cases presented here, new bone formation may be associated with IP pathologically. We also believe that additional investigations are required to characterize the pathophysiological mechanisms involved in neoplasm-induced osteogenesis.
Combined use of Fibrin Tissue Adhesive and Acellular Dermis in Dural Repair
Authors: Shah Anil R. , Pearlman Aaron N. , O'Grady Kevin M. , Bhattacharyya Tappan K. , Toriumi Dean M.
Published: October 2007

Background

The management of cerebrospinal fluid (CSF) leaks can be challenging. Acellular dermal grafts derived from human cadavers can be used as a replacement material when autogenous materials are unavailable. Fibrin tissue adhesive (FTA) is a wound support product that has been used for hemostatic and tissue fixation purposes. The combined use of acellular dermis in conjunction with FTA for dural repair remains a subject of study. The aim of this study was to evaluate wound healing and tissue compatibility characteristics of acellular dermal substitute material when used both with and without FTA, for repair of a dural tear in a chinchilla model.

Methods

Forty-nine chinchillas were included in this randomized case-control study. The squamous portion of the temporal bone was removed to expose the tegmen. A 2 X 2 mm dural defect was removed to create an iatrogenic CSF leak. Then, animals were randomly assigned to one of three treatment groups: group 1, acellular dermis alone; group 2, acellular dermis with FTA; group 3, fibrinogen, acellular dermis, and FTA. Surgical sites were examined grossly at 1- and 2-week intervals. Temporal bones were examined histologically.

Results

Grossly, groups 2 and 3 had significantly less visible CSF leak and brain herniation noted at both 1- and 2-week intervals when compared with group 1. Histological results confirmed the gross results showing the best seal in group 2 and 3.

Conclusion

Acellular dermis combined with FTA provided superior support compared with acellular dermis alone in repair of induced dural defects.
Standardization of Diagnostic Criteria for Eosinophilic Chronic Rhinosinusitis in the Oestrus Ovis Infected Sheep Model
Authors: Thomas Devika C. , Surg M. , Wormald Peter-John
Published: October 2007

Background

The sheep is an established model for endoscopic surgical procedures, as well as for postsurgical healing. Standardization of the presence and the degree of eosinophilia within this model still has not been done. This study was undertaken to show the eosinophilic response secondary to Oestrus ovis parasitic infestation within the nasal cavity to standardize the sheep model of chronic rhinosinusitis (CRS) and to set diagnostic criteria for CRS in sheep.

Methods

Nasal mucosal secretions were obtained from sheep naturally infested with O. ovis and showed signs of CRS and from sheep treated with ivermectin to prevent the infestation. Full thickness mucosal biopsy specimens from the lateral nasal wall were obtained also from these sheep. After histological fixing and staining, the degree of eosinophilia in the mucous secretion smears and in the epithelial layer of the lateral nasal wall was quantified using a light microscope.

Results

The average number of eosinophils in the mucous secretions and in the nasal wall epithelium was significantly higher in the sheep that showed signs of rhinosinusitis and had visible O. ovis larvae compared with control sheep (p = 0.003 and p = 0.05, respectively).

Conclusion

Based on the average numbers of eosinophils observed the diagnostic criterion for CRS in sheep is two eosinophils per high-power field averaged over three fields of secreted mucous smears or an average of at least one eosinophil per high-power field of nasal wall epithelial biopsy specimens.
Endoscopic Reconstruction of Large Anterior Skull Base Defects using Acellular Dermal Allograft
Authors: Germani Ross M. , Vivero Richard , Herzallah Islam R. , Casiano Roy R.
Published: October 2007

Background

Endoscopic repair of small- to medium-sized anterior skull base (ASB) defects using bone, cartilage, fascia, fibrin glue, lipolized dura, and, more recently, acellular dermal allograft have all been described with equal efficacy. The purpose of this study was to review our experience with the use of acellular dermis as the sole graft material in endoscopic reconstruction of large ASB defects.

Methods

A retrospective chart review of all patients who underwent endoscopic repair of ASB defects at the University of Miami between the years of 2001 and 2006 was conducted. Fifty-six patients were identified who met these criteria. All repairs were performed by a transnasal, endoscopic approach. Outcome measures included success of graft take and incidence of major and minor complications. Dural defect size was defined as small (<0.4 cm), intermediate (0.4–2.0 cm), and large (>2.0 cm).

Results

AlloDerm (AlloDerm. LifeCell Corp. Woodlands, TX) was used as the primary graft material in 30/55 (55%) cases; 16/55 (29%) of the repaired defects were classified as large. Graft success was 97% in the AlloDerm group and 92% in the non-AlloDerm group. The incidence of major and minor complications in the AlloDerm group was 0 and 3.3%, respectively. In the non-AlloDerm group, the incidence of major and minor complications was 4 and 12%, respectively. There were no statistical differences in the complication rates based on the type of repair or defect size.

Conclusion

Alloderm can be used successfully to repair ASB defects, including large defects that are >2 cm in size with little or no morbidity.
A Cadaveric Model for Balloon-Assisted Endoscopic Paranasal Sinus Dissection without Fluoroscopy
Authors: Citardi Martin J. , Kanowitz Seth J.
Published: October 2007

Background

Recently, balloon catheter (BC) dilatation of paranasal sinus ostia has been introduced. In this procedure, a balloon-tipped catheter is placed across a sinus ostium over a flexible wire under fluoroscopic guidance, and inflation of the balloon enlarges the ostium. Some rhinologists have criticized this procedure for its failure to remove tissue and bone, especially in the setting of sinonasal polyposis. This project seeks to develop strategies for incorporating BC technology into standard functional endoscopic sinus surgery procedures.

Methods

Endoscopic sinus dissection of three human cadaveric heads was performed with conventional instruments supplemented by lacrimal duct BCs (LacriCATH; Quest Medical, Allen, TX). No fluoroscopy was used. Each dissection was videotaped for later review.

Results

For frontal recess dissection, these steps were performed under endoscopic visualization: (1) passage of the BC between frontal recess partitions, (2) BC inflation, and (3) removal of fractured frontal recess partitions with conventional instruments. This approach was used successfully in each frontal recess. Under endoscopic visualization, a BC was passed into the sphenoid ostium and inflated; this maneuver successfully dilated each sphenoid ostium. It was not feasible to reliably pass the BC through the natural maxillary ostium. Each BC was inflated to 8 atm for 30 seconds. No evidence of orbital or skull base injury was noted. No fluoroscopy was used.

Conclusion

BCs may be used as adjunctive instrumentation for endoscopic sinus dissection without fluoroscopy. This strategy warrants additional technical and clinical development.
Socioeconomic Factors in Allergic Fungal Rhinosinusitis with Bone Erosion
Authors: Ghegan Mark D. , Wise Sarah K. , Gorham Edward , Schlosser Rodney J.
Published: October 2007

Background

Previous studies have shown an increase in the incidence of orbital and skull base erosion in African Americans and males diagnosed with allergic fungal rhinosinusitis (AFRS). However, underlying reasons for the advanced presentation of AFRS in certain ethnic and gender groups are currently unknown. We evaluated several socioeconomic and demographic factors for their possible contribution to advanced presentation of AFRS in our patient population. Such factors have not been examined previously in the literature. The aim of this study was to evaluate the contribution of race, ethnicity, and various socioeconomic factors to the advanced presentation of AFRS with orbital and skull base bone erosion.

Methods

Retrospective review of medical records and radiological studies were performed for 54 consecutive AFRS patients presenting to a tertiary care rhinology practice. Presence of radiological evidence of bone erosion was compared with demographic data and insurance status, as indicated in the medical record. Bone erosion status was evaluated also against state demographic data, divided by county.

Results

Males were significantly more likely to present with bone erosion than females (p = 0.009). In this analysis, age and race were not statistically associated with the presence of bone erosion. Additionally, no statistically significant correlations were identified between bone erosion and several socioeconomic factors listed from the patient's county of residence (percentage below the poverty level, median household income, population percentage of African Americans, or number of physicians per 1000 residents).

Conclusion

No socioeconomic factors were identified that correlated with the incidence of bone erosion in patients diagnosed with AFRS. Factors other than socioeconomic status and access to health care appear to play a role in the advanced presentation of AFRS.
Endoscopic Endonasal Study of the Maxillary Nerve: A New Orientation
Authors: Herzallah Islam R. , Elsheikh Ezzeddin M. , Casiano Roy R.
Published: October 2007

Background

Endoscopic endonasal procedures for advanced lesions involving the pterygopalatine fossa (PPF) and its various communications are increasingly performed. The maxillary division of the trigeminal nerve (V2) passes through the foramen rotundum and crosses the upper part of the PPF, with a risk of partial or complete injury during surgery in this complex region. Despite the available knowledge of the sinonasal anatomy, the endoscopic orientation of the V2 remains unclear and requires further analysis from this unique view.

Methods

Using an extended endoscopic approach, the PPF was dissected in 20 sides of 10 adult cadaver heads. The V2 also was followed anteriorly from the trigeminal ganglion, toward the infraorbital canal. The course and the neurovascular relationships of the V2 were studied. High-quality endoscopic images have been produced by coupling the video camera to a digital video recording system.

Results

The endoscopic course and relations of the V2 were carefully described. Important landmarks to identify and avoid injury of the nerve were discussed in relation to this unique view.

Conclusion

This study updates our understanding of the V2 anatomy from an endoscopic perspective. The medial to lateral inclination and drooping of the V2, as well as different relationships of the V2 with the vascular structures are important findings to be taken into consideration while endoscopically addressing related lesions.
Endoscopic Anatomy of the Pterygopalatine Fossa
Authors: Isaacs Seth J. , Goyal Parul
Published: October 2007

Background

The pterygopalatine fossa can be involved with a variety of infectious and neoplastic processes. This region can be entered endoscopically, but endoscopic landmarks to localize the neurovascular structures in the pterygopalatine fossa have not yet been reported.

Objectives

The purpose of this study is to describe the location of the neurovascular structures in the pterygopalatine fossa in relation to consistent intranasal landmarks.

Methods

Endoscopic dissections of cadaveric heads were performed. The locations of neurovascular structures in the region were defined.

Results

The sphenopalatine foramen (SPF) served as the primary intranasal landmark to the pterygopalatine fossa (PPF). Mean distances from the SPF were measured with the following results: SPF to sphenopalatine ganglion (SPG), 4 mm medially and 6 mm laterally; SPF to foramen rotundum (FR), 7 mm; and SPF to vidian canal (VC), 2 mm. The internal maxillary artery followed an irregular and inconsistent course, making it difficult to define a reliable landmark for its location in the fossa.

Conclusion

Entering the PPF inferior to the horizontal plane of the SPF along a vertical line drawn inferiorly from the infraorbital canal will avoid injury to the major neural structures in the fossa. Because of the inconsistent course and location of the internal maxillary artery, this structure may be at risk no matter where the fossa is entered. These landmarks will allow the surgeon to enter the PPF with more accuracy and less patient morbidity.
Clinical Outcomes of Endoscopic and Endoscopic-Assisted Resection of Inverted Papillomas: A 15-Year Experience
Authors: Woodworth Bradford A. , Bhargave Geeta A. , Palmer James N. , Chiu Alexander G. , Cohen Noam A. , Lanza Donald C. , Bolger William E. , Kennedy David W.
Published: October 2007

Background

The endoscopic resection of sinonasal inverted papillomas (IPs) has been well described. However, the majority of published reports in the literature are small case series with limited clinical follow-up. The aim of this retrospective study was to review the experience with the endoscopic and endoscopic-assisted resection of IPs at a major academic tertiary care facility and assess long-term outcomes.

Methods

A retrospective review of endoscopic and endoscopic-assisted resections of IP was performed. Charts were reviewed for standard demographic data, operative technique, adjuvant approaches, complications, and postoperative follow-up times.

Results

One hundred fourteen patients (average age, 56 years) underwent endoscopic or endoscopic-assisted resection for IPs with a mean disease-free follow-up of 40 months (7–135 months). Seventeen patients developed disease after endoscopic or endoscopic-assisted resection for a recurrence rate of 15%. Average time to recurrence was 23 months. Combined approaches were used when indicated in 34% (39/114) of patients, including adjuvant osteoplastic flap, midface degloving, trephine, or Caldwell-Luc approaches. Four patients (4%) had cerebrospinal fluid leaks that were successfully repaired endoscopically.

Conclusion

In this large series of endoscopically resected IPs with extensive clinical follow-up, recurrences occurred an average of 23 months after the procedure. This emphasizes the importance of long-term endoscopic follow-up to detect recurrences in all patients. Endoscopic or endoscopic-assisted resection of IPs is a valid technique in this series with recurrence rates comparable with open approaches.