bluuebunny/crossref_metadata_2025 huggingface dataset:
Airflow and the Nasal Cycle: Nasal Patency Fluctuations after Laryngectomy
Authors: Fisher Edward W. , Liu Ming , Lund Valerie J.
Published: September 2007

A periodic fluctuation in nasal patency or “nasal cycle” is observed in the majority of adults but has not hitherto been demonstrated in individuals after diversion of nasal airflow. Acoustic rhinometry, a highly sensitive technique which does not require airflow, provided the opportunity to evaluate this situation in patients who had undergone laryngectomy. We examined 21 postoperative individuals (mean postoperative time 4 years) and 14 control subjects matched for age (including 2 patients prelaryngectomy). Acoustic rhinometry was performed serially over 3–8 hours to determine minimum cross-sectional area and nasal cavity volume as indices of nasal patency. Fluctuations in nasal patency were observed in all laryngectomees and controls. These were classified as classical (reciprocal alternating), in concert (parallel) or irregular. The distribution of the control and laryngectomy subjects between the cycle categories was not statistically significant (Fisher's exact test: P > 0.05). The mean periodicity of the cycle was similar in the two groups (controls: 180 minutes, laryngectomees: 176 minutes), but the mean amplitude was significantly less in the laryngectomy group (68 versus 96 cm3; P < 0.07 Mann-Whitney U test). The nasal cycle can continue after cessation of airflow, but it is diminished in amplitude. Therefore, afferent input from nasal airflow receptors may continue to play a role in modulating the cycle's periodicity and amplitude, but are not responsible for generating the underlying cycle phenomenon.
Chemosurgery with Trichloroacetic Acid for Allergic Rhinitis
Authors: Yao Kazuo , Shitara Tetsuya , Takahashi Hiro-omi , Nishiyama Kouichiro , Iguchi Yoshiaki , Yamamoto Kazuhiro
Published: September 2007

The use of 80 w/v% solution of trichloroacetic acid (TCA) for the treatment of allergic rhinitis was reported. The solution was applied to the inferior turbinates only once bilaterally. The result of the treatment in 77 nonselected cases of perennial allergic rhinitis for over 3 years showed that an improvement was obtained in 72% for nasal obstruction, 60% for sneezing, and 50% for watery nasal discharge. The result of provocation tests after treatment showed an improvement in 77% of the cases, and the histamine concentration in the nasal wash decreased. These results were discussed with reference to the result of our previous histological studies. We concluded that our method of treatment using TCA was simple and effective for allergic rhinitis without any serious side effects.
Lateral Rhinotomy Approach to Inverted Papilloma
Authors: Kraus Dennis H.
Published: September 2007

The successful surgical management of inverted papilloma requires total tumor extirpation. This article will review the technique of lateral rhinotomy and indications for its use. Prevention of complications will be stressed. Literature review focusing on the efficacy of this procedure will be presented. A brief review of midfacial degloving will also be included. Its use for limited, noninvasive lesions will be described. Lateral rhinotomy remains the gold standard against which all other procedures must be compared.
The Effect of Humidity on the Regeneration of the Human Nasal Mucosa
Authors: Anselmo-Lima Wilma Terezinha , de Oliveira José Antonio A. , Gonçalves Renato Pinto
Published: September 2007

Regeneration of the epithelium of the human nasal mucosa was studied by electron microscopy in order to determine whether the epithelium renews according to environmental conditions. The epithelium was removed by curettage, and the time of epithelium regeneration was found to be 72 hours, as was also observed in other mammals. The results clearly showed that regeneration always occurred in all 14 individuals studied, with no different turnover patterns in different environments, but with the predominance of individual variation.
The Effects of Sinus Surgery on Midfacial Growth in the Rabbit
Authors: Pinkston D. Randall , Schubkegel Andrew J. , Zimmerman M. Bridget , Smith Richard J.H.
Published: September 2007

The effects of pediatric sinus surgery on craniofacial growth have not been established. This study was designed to determine whether sinus surgery influences midfacial growth in New Zealand white rabbits. Surgery was performed on five groups of six rabbits each: Group 1—bilateral external dorsal approach to the maxillary sinus with enlargement of the sinus ostium and removal of the uncinate process; Group 2—bilateral external dorsal approach to the maxillary sinus; Group 3—unilateral external dorsal approach to the maxillary sinus with enlargement of the sinus ostium and removal of the uncinate process; Group 4—unilateral external dorsal approach to the maxillary sinus; Group 5—no operation. Rabbits were killed as adults, and dried skull measurements were performed using a Polhemus 3-space digitizer. Statistically significant regional restriction of midfacial growth was demonstrable when comparing Groups 1–4 with Group 5, and between sides in Groups 3–4. Enlargement of the sinus ostium and uncinectomy caused foreshortening of the snout on the operated side in Group 3. This effect was not observed following the approach alone in Group 4. These results suggest that midfacial growth is affected by sinus surgery in rabbits. Further animal studies should be done to test this hypothesis, and in the interim, a conservative approach to sinus surgery in children would be prudent.
Radiological Abnormalities of Paranasal Sinuses in Asthmatics with Rhinitis
Authors: Sircar Mrinal , Karol Rajesh K. , Bhatia Promila
Published: September 2007

A total of 114 patients with asthma and coexisting rhinitis were screened radiologically for abnormalities suggestive of paranasal sinus (PNS) disease. We found such radiological abnormalities in 87 (76.3%) patients. Of these, 79 (90.8%) had involvement of maxillary sinuses, 29 (33.3%) of frontal sinuses, and 8 (9.2%) of sphenoidal sinuses. Sixteen (18.4%) patients had single sinus involvement, none being that of sphenoidal sinuses. We found erect occipito-mental (Water's) view most useful for the radiological screening of the PNS. Significance of these findings and possible clinical implications are reviewed. Radiological evaluation of the PNS is suggested to select patients requiring evaluation for sinusitis.
Nontraumatic Carotid-Ophthalmic Aneurysm Presenting as Recurrent Epistaxis
Authors: Kotton Darrell , Kotton Bernard , Itani A.L.
Published: September 2007

Recurrent epistaxis can be a rare presentation of ruptured internal carotid artery aneurysm. Although primarily a neurosurgical problem, these cases may be seen initially by the otolaryngologist, as the aneurysm erodes through the thin adjacent sphenoid sinus wall and ruptures, producing epistaxis. In most cases these aneurysms are traumatic in origin. We present the first cited case of a nontraumatic internal carotid aneurysm, arising from the origin of the ophthalmic artery, which presented as intermittent epistaxis from the sphenoid sinus. We suggest that aneurysmal rupture be considered in the differential diagnosis of all cases of epistaxis from the sphenoid sinus. Nasal endoscopy and CT scan of the paranasal sinuses in non-emergent cases is valuable in localizing the source of the bleed. Furthermore, preoperative angiography is essential in making the diagnosis of aneurysm and avoiding fatal torrential hemorrhage caused by nasal surgery. Once the diagnosis is made, the definitive treatment is surgical or intravascular trapping of the aneurysm.
Distribution of Mast Cells in Inverted Papilloma and Squamous Cell Carcinoma of the Nose
Authors: Yokoshima Kazuhiko , Ohnishi Masaki , Takizawa Ryuta , Okubo Kimihiro , Okuda Minoru , Yagi Toshiaki
Published: September 2007

An increased number of mast cells is found in the epithelial layer of the nasal mucosa of allergic subjects. However, the mechanism of accumulation of the intraepithelial mast cells has not yet been clarified. We have previously shown that the increase of intraepithelial mast cells is related to the proliferation of nasal epithelial cells in vivo, and inverted papilloma and squamous cell carcinoma of the nose seem to be in vivo proliferative states of nasal epithelium. To clarify the mechanism of the accumulation of intraepithelial mast cells, we studied the relationship between nasal tumors of epithelial cell origin and the accumulation of mast cells. Accumulation of mast cells was observed in the nasal inverted papilloma, especially within 50μm from the basement membrane at the tumor site, which might be the site of maximum proliferation of tumor cells as well as secretion of cytokines. The majority of mast cells accumulated were formalin sensitive mast cells (mainly MMCs). On the other hand, in the squamous cell carcinoma of the maxillary sinus, fewer mast cells were found. Results of this study suggest that the accumulation of intraepithelial mast cells is associated with the proliferation of nasal epithelial cells.
Intranasal Histamine, Methacholine, and Bradykinin Challenge in Children with and without Allergy
Authors: Vayonis Andrew G. , Seroky James T. , Doyle William J. , Skoner David P. , Fireman Philip
Published: September 2007

In this study, allergic and non allergic children (7–13 years) were challenged with increasing doses (0.01, 0.1, 1.0 mg) of histamine, methacholine, and bradykinin at different study sessions. The effects of these challenges on nasal patency, secretion weight, sneezing, nasal symptoms, eustachian tube function, middle-ear pressure, and pulmonary function were documented. Although intranasal challenges with the three substances provoked nasal symptoms and secretion, only histamine challenge provoked sneezing and resulted in significant changes in the measures of nasal patency and eustachian tube function. None of the substances provoked changes in middle ear pressures or pulmonary function. Allergic status had a significant effect on secretion weight and symptoms of congestion and rhinorrhea, most consistently documented as a greater response of the allergic subjects to histamine challenge. In general, the results of this study in children are similar to those previously described for challenges with these substances in adults.
Histopathologic Analysis of Chronic Sinusitis
Authors: Goldwyn Benzion G. , Sakr Wael , Marks Steven C.
Published: September 2007

Histology of sinusitis has been well described in qualitative terms. However, to date no attempts have been made to provide criteria to judge the severity of inflammation in sinusitis. In this study we attempted to evaluate and quantify the inflammatory process in sinusitis. The pathological specimens of patients undergoing surgery for chronic sinusitis was evaluated and scored on a 0–4 + scale based on the severity of inflammation. In addition, each case was analyzed for cellular infiltrate. Ten high power fields were randomly examined, with mean cell counts per high power field recorded for lymphocytes, eosinophils, polymorphonuclear leukocytes, and total cells. Results indicate that the 0–4 + scale is a poor predictor of inflammatory density. Furthermore, a spectrum of severity from normal to dense cellular infiltrates is seen. Correlation to computer tomography staging is presented.
Erythromycin Inhibits Adhesion of Pseudomonas Aeruginosa and Branhamella Catarrhalis to Human Nasal Epithelial Cells
Authors: Ishida Lilian Konno , Ikeda Katsuhisa , Tanno Noriko , Takasaka Tomonori , Nishioka Kiyo , Tanno Yasuo
Published: September 2007

Ciliated epithelial cells were obtained from nasal polyps. Bacterial adherence to these cells was compared for the ability to bind Hemophilus influenzae, Pseudomonas aeruginosa, and Branhamella catarrhalis in the presence of 10–5 M erythromycin, which was comparable with a physiologically attainable concentration in the nasal secretion and the maxillary sinus mucosa. Quantification of bacterial adherence showed the strongest ability of P. aeruginosa to the cells. Erythromycin has an inhibitory effect on adherence of P. aeruginose and B. catarrhalis to the nasal epithelial cell. Our findings suggest that the reduced adherence to the host cell is one of the underlying mechanisms to account for efficacy of erythromycin treatment in respiratory disorders.
Acoustic Rhinometry in the Diagnosis of Occupational Rhinitis
Authors: Hytönen Maija L , Sala Eeva L , Malmberg Henrik O , Nordman Henrik
Published: September 2007

Acoustic rhinometry (ARM) has been used to study the nasal cavity geometry and the response in nasal provocations. However, the use of ARM in the diagnosis of occupational rhinitis (OR) has not been reported. The purpose of this study was to find an ARM parameter and a limit value that could be used in provocation tests to express an objective change in the nasal cavity geometry. We used a new calculated parameter, Volume MCA%, for describing the change in the nasal geometry. Volume MCA% is the mean of the percentile changes of nasal volumes and minimal cross-sectional areas in a provocation test. We recommend a decrease of at least 15% in Volume MCA% for the limit of an essential change in the nasal cavity.
A Case of Leukocyte Adhesion Deficiency (LAD) Presenting with Nasal Septum Perforation and Necrotizing Ulcer on Ala Nasi
Authors: Tezcan Ilhan , Yel Leman , Önerci Metin , Sanal Özden , Ersoy Fügen , Berkel A. Izzet
Published: September 2007

We report on a 3 month-old female patient having leukocyte adhesion deficiency (LAD) of severe phenotype presenting with perforation of the nasal septum and ulceration on the right ala nasi. Laboratory investigations revealed marked leukocytosis, defective neutrophil adherence to glass beads and chemotaxis, decreased NK cell cytotoxicity, and undetectable expression of CD18 on lymphocytes. We conclude that the possibility of this entity should be kept in mind in the presence of such a necrotic lesion in early childhood.
Pediatric Functional Endoscopic Sinus Surgery
Authors: Rothman Glenn B. , Tunkel David E. , Baroody Fuad M. , Naclerio Robert M.
Published: September 2007

Based on experience with functional endoscopic sinus surgery in over 200 children, we suggest that technical considerations modify the approach in the pediatric patient. We present details of our surgical approach with emphasis on modifying the uncinectomy. We believe our modifications reduce the incidence of recurrent disease.
Microbiology of the Maxillary Sinus in Adults with Chronic Sinus Disease
Authors: Winther Birgit , Vickery Christopher L. , Gross Charles W. , Hendley J. Owen
Published: September 2007

Antimicrobial therapy is a part of the care of patients with chronic sinus disease (CSD), but the etiologic role of microorganisms in this condition is unclear. Twenty patients with CSD undergoing functional endoscopic sinus surgery who had been off antibiotics for at least 1 week before surgery had a maxillary sinus aspirate for quantitative culture for aerobic bacteria and fungi and a semiquantitative culture from the antrostomy of the same maxillary sinus during endoscopic surgery. Six (30%) of the patients had infection of the maxillary sinus diagnosed by the presence of ≥ 103 cfu/mL of organisms in the sinus aspirate (Haemophilus influenzae in two patients and one patient each with Moraxella catarrhalis, α-streptococcus, mixed oropharyngeal flora, or Alternaria sp.). All antrostomy specimens obtained by nasal endoscopy during surgery were positive, but the antrostomy cultures did not correlate with the sinus aspirate cultures from the same sinus. Staphylococcus aureus and/or Gram negative rods in eight antrostomy cultures did not predict the presence of these pathogens in any of the maxillary sinus aspirates. Conversely, the bacteria detected with the quantitative aspirate culture in five of the six infected sinuses were not found in the antrostomy specimen; only the fungal sinus infection correlated with the antrostomy culture. Infection of the maxillary sinuses occurred in patients with both limited and severe disease by CT imaging. About one third of patients with CSD necessitating surgery had microbial infection of the maxillary sinus, but antrostomy cultures obtained via endoscopy did not predict the organisms infecting the sinus.
Surgical Anatomy and Variations of the Onodi Cell
Authors: Weinberger Debra G. , Anand Vijay K. , Al-Rawi Mouwafak , Cheng Han J. , Messina Albert V.
Published: September 2007

Onodi cells are posterior ethmoid cells superolateral to the sphenoid sinus that is intimately associated with the optic nerve. Embryologically, they are derived from ethmoid cells that have undergone dedifferentiation. The anatomic relationship of the Onodi cell to the optic nerve and the internal carotid artery has not been clearly documented in the literature. Forty-four sagittal sections of cadaver heads and 83 CT scans of the sinuses were examined. Case studies of three patients with Onodi cell sinusitis are presented. Two patients underwent endoscopic sinus surgery, and the other chose conservative medical management. The cadaver specimens revealed Onodi cells in 14% (6/44 sections). They were located lateral, superior, or superolateral to the sphenoid sinus. These relationships were further delineated by studying CT scans of the sinuses of 76 patients. Six patients (8%) had Onodi cells. Four of them had a dehiscence of the optic nerve adjacent to the Onodi cell. Twelve patients (16%) demonstrated a dehiscence of the internal carotid artery. These findings have important implications in endoscopic sinus surgery. The anatomic variability of the posterior ethmoids, sphenoid sinus, internal carotid artery, and optic nerve makes this surgical approach particularly challenging.
Endoscopic Pituitary Surgery: A Minimally Invasive Technique
Authors: Sethi Dharambir S. , Pillay Prem K.
Published: September 2007

The sublabial transseptal transsphenoidal approach using the operating microscope to provide illumination and magnification is the standard approach for the majority of pituitary adenomas in most institutions. This approach combines a sublabial incision with a transfixion incision, and often requires removal of the anterior nasal spine and dislocation or removal of the quadrilateral septal cartilage. We describe an endoscopic technique that is minimally invasive, requiring only a hemitransfixion incision, and preserving the anterior nasal spine. Often, it is not necessary to dislocate the septal cartilage from the maxillary crest. The surgery is performed using a 4 mm 0 degree telescope. Angled 30 degree and 70 degree telescopes are used to visualize the intrasphenoid anatomy, and may be introduced in the sellar cavity following tumor removal, to ensure complete extirpation. This minimally invasive technique has been successfully used in 80 patients with sellar lesions. The use of endoscopes offered not only the advantage of improved visualization, but also magnification and a panoramic perspective of the important anatomical relationships of the sella turcica. It also enabled more complete tumor removal with minimally invasive techniques.
Comparison of the Relative Abilities of Acoustic Rhinometry, Rhinomanometry, and the Visual Analogue Scale in Detecting Change in the Nasal Cavity in a Healthy Adult Population
Authors: Tomkinson A. , Eccles R.
Published: September 2007

The relative abilities of acoustic rhinometry, rhinomanometry, and subjective sensation of nasal patency, as recorded using a Visual Analogue Scale (VAS), were compared in a group of 51 healthy volunteers. All three methods were able to detect a change following the application of a nasal decongestant. A 27.5% change in minimum cross sectional area, a 13.29% change in nasal resistance, and a 30.7% change in the sensation of nasal patency was observed. No correlation was demonstrated between either acoustic rhinometry or rhinomanometry and subjective sensation, and only a weak correlation was found between acoustic rhinometry and rhinomanometry.
Carbonic Anhydrase in Human Nasal Epithelium: Localization and Effect of the Inhibition by Dichlorphenamide
Authors: Cavaliere Franco , Masieri Simonetta , Nori Stefania , Magalini Sergio I. , Allegra Salvatore R.
Published: September 2007

Carbonic anhydrase has not hitherto been reported in nasal mucosa. In the first part of this study, five specimens of human nasal mucosa from the inferior turbinate were obtained from five healthy subjects and tested for this enzyme with a histochemical reaction. Carbonic anhydrase was identified in the columnar ciliated respiratory epithelium, but was absent in the adjacent stratified squamous epithelium. The effect of the inhibition of this enzyme on the pH values and Na, K, and Cl activity in nasal secretion was subsequently investigated. Fifteen patients, affected by endocranial hypertension and to whom dichlorphenamide—an inhibitor of carbonic anhydrase—was administered, were studied. The pH value, determined with a surface electrode before giving the drug and 30, 60, and 90 minutes later, significantly increased and reached a peak at 60 minutes. Na, K, and Cl concentration was assessed by indirect potentiometry in the nasal secretion and in the plasma both before giving dichlorphenamide and 60 minutes later. Although no change was observed in the plasma, in the nasal secretion Na and Cl concentration increased and K concentration decreased. As a consequence, the gradients of Na and K between plasma and secretion decreased, and that of Cl increased. We assume analogous changes in the rate of transport through the mucosa to occur. These results thus suggest that carbonic anhydrase is involved in control of the pH of nasal secretions as well as in the electrolyte transport through the epithelium.
The Role of the p53 Tumor Suppressor Gene in the Tumorigenesis of Inverting Papilloma of the Nose and Paranasal Sinuses
Authors: Deutsch Mark D. , Li Ya-Qin , Utz Gary , McDonald John S. , Nguyen Charly , Pavelic Ljiljana , Wilson Keith M. , Gluckman Jack L. , Pavelic Zlatko P.
Published: September 2007

Inverting Papilloma (IP) is a rare neoplasm of the nose and paranasal sinuses. It is considered to be a premalignant lesion as there is a 7–21% incidence of squamous cell carcinoma (SCC) associated with IP. Although there have been many attempts to assign prognostic significance to various features of IP, there has not been a single reliable prognostic indicator identified. Recently it has been shown that mutations of the p53 tumor suppressor gene (TSG) are commonly involved in the process of cancer development. It has been assumed that cells which stain positive with p53 monoclonal antibody (MAb) contain mutant protein due to its lengthened half-life. To better understand the relationship of IP and carcinoma, we analyzed tumor specimens from 12 patients for p53 gene alterations using immunohistochemistry and DNA sequencing. Seven patients had IP without dysplasia, and five patients had IP with dysplasia or squamous cell carcinoma (SCC). All seven patients with IP only had tumors negative for p53 TSG. Three of five patients with IP and dysplasia or SCC stained positive for p53 TSG. No gene alterations of p53 TSG were detected in this study. The role and significance of p53 TSG in the tumorigenesis of IP is discussed based on these findings.
Linear Impulse Osteotome for Rhinoplasty
Authors: Mason John C. , Park Stephen S. , Gross Charles W.
Published: September 2007

The 2500 Impactor linear impulse osteotome (MicroAire® Surgical Instruments, Charlottesville, VA) is a new power instrument for the rhinoplasty surgeon. Air pressure drives the osteotome in linear, oscillating pulses, which allows for easy bone cuts. Dorsal hump reduction and a variety of osteotomies were performed on seven cadavers; results were compared with those from traditional osteotome and mallet. Results show equal accuracy and precision, with the degree of soft tissue injury and bone comminution being minimal by each technique. Dorsal hump reduction with the Impactor was performed in a single maneuver starting at the anterior septal angle, cutting easily through the rigid cartilaginous dorsum. The Impactor was used to perform osteotomies on two patients with nasal deformities and satisfactory reductions were achieved. The major distinction with this instrument is the tremendous ease with which bone cuts are made. Minimal pressure is needed as the Impactor advances through bone. In addition, the Impactor offers single operator use and a unique method of reducing a prominent nasal dorsum.
The Effect of Zileuton on Anosmia in Aspirin-Sensitive Asthmatics
Authors: Wooding L. Gretchen , Incaudo Gary A.
Published: September 2007

Anosmia is a common accompanying symptom in aspirin-sensitive asthmatics with the “ASA Hypersensitivity Triad” of eosinophilic rhinitis, nasal polyposis, and hyperplastic sinusitis. During a 12-month investigational drug trial with Zileuton, an inhibitor of 5-lipoxygenase, 3 of 12 patients with mild to moderate asthma were identified to be aspirin-sensitive and anosmic. We describe these three cases and their olfactory response using a three item forced choice odor identification test. All three patients noted persistent improvement in their sense of smell after institution of Zileuton and during the first 12 months of drug administration. Inhibition of the production of leukotrienes by 5-lipoxygenase inhibition may cause clinically significant reduction in upper airway inflammation in aspirin-sensitive patients.
Healing Process of Sinus Mucosa after Endoscopic Sinus Surgery
Authors: Moriyama Hiroshi , Yanagi Kiyoshi , Ohtori Nobuyoshi , Asai Kazuyasu , Fukami Masaya
Published: September 2007

In the treatment of chronic sinusitis, the mucosa should be preserved, or, when severely damaged, only the mucosal surface removed with cutting forceps. It is especially important not to expose the surface of the bone by complete removal of the mucosa. When the mucosa is conserved, or excision is limited to only the mucosal surface, ciliated cells regenerate within 6 months. However, where the mucosa was completely removed during surgery and the bone was exposed, the area was covered with nonciliated cells, and only scattered cilia were present.
Nasal Challenge, Skin Tests, and Serum Antibodies in the Diagnosis of Latex-Induced Occupational Rhinitis
Authors: Kujala Veikko M. , Pirilä Tapio , Kurup Viswanath P. , Reijula Kari E.
Published: September 2007

The purpose of the study was to develop a suitable natural rubber latex (NRL) antigen powder and a control material for the nasal application of the test reagent and to evaluate the nasal provocation test (NPT) response pattern in latex allergic and nonlatex allergic subjects with a suspicion of latex-induced rhinitis. A questionnaire was completed among health care workers (n = 268) in one hospital. Seven health care workers who had upper respiratory symptoms associated with daily usage of latex gloves were examined by using skin prick test (SPT), NPT, and sinus plain X-ray. NRL allergen for the nasal challenge was collected from surgical gloves. The powder was obtained by washing the gloves, freeze-drying the solution, and the powder was then used in NPT. As a negative control, clean corn starch powder was applicated on nasal mucous. SDS-PAGE analysis of the NRL test powder was performed. After the nasal challenge, one of seven workers showed rhinorrhea, a significant increase in nasal obstruction, and in the amount of nasal secretion in NPT. This patient also showed a positive SPT to NRL allergens and an elevated NRL specific IgE level in her serum. In six patients NPT, SPT, and specific IgE for latex were negative. SDS-PAGE analysis of the glove powder showed a major NRL antigen, with molecular weight of 14 kDa. The NPT may be used in persons with a suspicion of latex-induced rhinitis and borderline skin and humoral test results for NRL and in subjects with heavy glove powder-associated nasal symptoms but negative skin and humoral tests for latex. Only well known test reagents should be used in NPT.
Cytometric Characteristics and Proliferation of Inverted Papillomas of the Paranasal Sinuses
Authors: Haibt-Lüttke Gabriele I. , Welkoborsky Hans J. , Hinni Mike , Mann Wolf J. , Amedee Ronald G.
Published: September 2007

Inverted papillomas are rare tumors of unknown histologic origin occurring in the nasal cavity and the paranasal sinuses. Specimens from 27 patients with histologically confirmed inverted papillomas were assessed by DNA analysis and immunohistochemical identification of the proliferating cell nuclear antigen (PCNA). One of the patients had squamous cell carcinoma associated with the inverted papilloma. According to the results of DNA analysis, patients with inverted papillomas would be divided into two groups. One group demonstrated low DNA indices and a low PCNA score. The second group showed higher DNA values associated with an increased proliferation rate. Two patients from each group developed recurrent disease. The recurrent papillomas from the patients in the first group demonstrated the same low DNA indices as were observed in the primary tumors. The recurrences from the patients in the second group occurred 1.5 and 2 years, respectively, following the primary surgery. Although the primary tumors had high DNA indices, the recurrences demonstrated a further increase of the DNA indices with cytological signs of malignancy. Quantitative DNA analysis and PCNA scoring offers a new, reliable means of assessing inverted papillomas and may possibly predict those tumors that behave more aggressively. Close follow up of patients presenting with high DNA indices and elevated PCNA scores is recommended.
Endoscopic Drainage of Subperiosteal Abscess in Children: A Pilot Study
Authors: Younis Ramzi T. , Lazar Rande H.
Published: September 2007

Subperiosteal abscess is a serious orbital complication of sinusitis that occurs predominantly in children. Infection may spread to the orbital site through a preexisting defect in the lamina papyracea or by means of a thrombophlebitic process. Although the traditional approach to treating a subperiosteal abscess has been drainage through an external incision, we treated this serious complication with functional endonasal sinus surgery. Ten pediatric patients with clinical and CT evidence of orbital subperiosteal abscess underwent endoscopic surgery at LeBonheur Children's Hospital in Memphis, Tenn., between July 1990 and June 1992. The four girls and six boys were between 3 and 12 years of age at the time of surgery. Despite 2 to 4 days of intravenous antibiotic therapy, their signs and symptoms progressed, and axial and coronal CT scans demonstrated orbital subperiosteal abscess. Seven patients had bilateral ethmoid and maxillary sinusitis, and the remaining three patients had unilateral ethmoiditis. Ophthalmologic assessments were performed for all patients immediately after hospital admission. The patients were started on regimens of high-dose intravenous cefuroxime sodium to subdue infections and pediatric decongestant nasal spray to facilitate drainage. All 10 patients with the confirmed diagnosis of subperiosteal abscess were treated with endoscopic surgery to drain the site of infection. All 10 patients improved significantly 12 to 24 hours after surgery and were discharged from the hospital to their homes 48 to 72 hours after surgery. Patients were continued on a regimen of broad-spectrum oral antibiotics and beclomethasone nasal spray for 2 weeks beyond the final examination. Follow-up endoscopic examinations were performed under general anesthesia in the operating room 2 to 3 weeks after surgery. No complications or adverse sequelae occurred. Our study appears to confirm that endoscopic drainage of subperiosteal abscess offers the patient an alternative to incisional surgery. The endoscopic approach prevents an external scar without increasing morbidity or length of hospitalization.
Midfacial Degloving Approach to the Nose, Sinuses, and Skull Base
Authors: Har-El Gady , Lucente Frank E.
Published: September 2007

Thirty-seven patients with a variety of neoplastic, vascular, and traumatic lesions of the midfacial skeleton, orbits, and central compartment of the anterior and middle cranial fossae were managed surgically via the midfacial degloving approach. Excellent exposure was achieved in all patients. Complete removal of the lesion was achieved in all patients with neoplastic disease. Successful repair of the defect was achieved in all patients with traumatic injuries. The most common complication related to midfacial degloving was temporary infraorbital anesthesia or hypesthesia. Only one patient developed symptomatic nasal valve stenosis. Midfacial degloving has important advantages over other procedures, especially in cases where bilateral surgery is required or when the avoidance of midfacial incisions and scars is important. In the subgroup of inverted papilloma, midfacial degloving is currently our procedure of choice for en-block medial maxillectomy and ethmoidectomy.
Response of Olfactory Acuity to Surgical Stress
Authors: Holmström Mats , Lund Valerie J.
Published: September 2007

In this study, the effect on olfaction of surgical procedures, performed distant to the nose, was analyzed. Twenty-three patients planned for surgery of minor or moderate degree under general anaesthesia were examined before surgery for evaluation of sense of smell with the University of Pennsylvania Smell Identification Test and a smell threshold test (Olfacto-Labs). Reexamination was performed 24–48 hours postoperatively. Both tests demonstrated significant improvement in olfaction following surgery. The improvement was more obvious in younger patients and in patients undergoing moderate surgery compared with the minor surgery group but was, however, not statistically significant.
Development of the Paranasal Sinuses in Children
Authors: Medina Javier , Hernandez Hector , Tom Lawrence W.C. , Bilaniuk Larissa
Published: September 2007

The development of computed tomography and functional endoscopic sinus surgery has improved diagnosis and management of sinusitis. It has also renewed interest in the developmental anatomy of the paranasal sinuses. There are significant differences between adult and pediatric sinus anatomy, and to safely perform functional endoscopic sinus surgery in children, the surgeon must be aware of these differences. To define the developmental anatomy of the paranasal sinuses, we analyzed 145 computed tomograms from patients under 18 years of age. The study emphasized landmarks at the level of the maxillary sinus ostium. In addition, distances and angles from the nasal spine to various points in the sinuses were determined. The structures were identified and traced on a digitizing tablet. Means and standard deviations were calculated for each measure as a function of age. This study can aid a better understanding of sinus development in children and provide guidance to the endoscopic sinus surgeon.
Goblet Cell Density of the Inferior Turbinates in Patients with Perennial Allergic and Nonallergic Rhinitis
Authors: Berger Gilead , Marom Zvi , Ophir Dov
Published: September 2007

Nasal mucus production is regulated by submucosal glands and epithelial goblet cells. The role and especially the number of the latter are quite debatable. The present study compares the distribution and density of goblet cells in the inferior turbinates of patients with perennial allergic and nonallergic rhinitis to normal controls. The periodic acid Schiff-alcian blue whole-mount method was used to identify and count their number. Goblet cell distribution was found nonhomogeneous, and considerable variations were observed among adjacent localities of the same specimen. The mean number of goblet cells per mm2 was 6499 in normal controls (n = 12), 6818 in patients with perennial allergic rhinitis (n = 13), and 6801 in patients with perennial nonallergic rhinitis (n = 18). Statistical analysis confirmed that the density of goblet cells did not differ significantly between patients with and without allergy, as well as between each group of patients and controls. Therefore, it could be concluded that the number of goblet cells in the inferior turbinate is not influenced by the presence of perennial allergic or nonallergic rhinitis.
The Effects of Gelatin Film Stents in the Middle Meatus
Authors: Tom Lawrence W.C. , Palasti Sandra , Potsic William P. , Handler Steven D. , Wetmore Ralph F.
Published: September 2007

Controversy exists regarding the management of the middle meatus after pediatric functional endoscopic sinus surgery (FESS). To prevent adhesions following pediatric FESS, gelatin film stenting of the middle meatus has been recommended. The effects of stenting, however, have not been established. Fifty-one children with similar degrees of bilateral sinus disease had a gelatin film stent placed in one middle meatus on completion of FESS, while the opposite meatus was not stented. Two to three weeks later at the time of a second, staged procedure, the sides were compared for the presence of the stent, adhesions, granulation tissue, and patency of the maxillary sinus ostia. In 11 children the postoperative findings were more severe in the side without the stent, whereas in 29 children they were more severe in the stented side. There was no difference between the sides in 11 children. Although gelatin film stenting benefits some children, it should not be used routinely following pediatric FESS but should be reserved for children who are predisposed to develop adhesions or have poor prognostic factors, such as immunodeficiency and ciliary dyskinesia.
Facial Skeletal Growth after Endoscopic Sinus Surgery in the Piglet Model
Authors: Carpenter Kevin M. , Graham Scott M. , Smith Richard J. H.
Published: September 2007

This study examined the effects of varying degrees of endoscopic sinus surgery on the growing midface and snout in pigs. In this randomized, controlled experiment, thirty 40–60-pound pigs were placed in five experimental groups: (1) unilateral uncinectomy; (2) bilateral uncinectomy; (3) unilateral uncinectomy, anterior ethmoidectomy, maxillary antrostomy; (4) bilateral uncinectomy, anterior ethmoidectomy, maxillary antrostomy; (5) unoperated controls. Animals were killed after 3 months and growth was assessed, according to linear and spatial measurements of multiple craniofacial regions. Euclidean distance matrix analysis showed significant restrictive shape alterations in a linear fashion in groups 1–4 (p < .05). These alterations occurred in the surgical field of the snout, midsnout, and maxilla. Endoscopic sinus surgery causes significant restrictive effects in the growing porcine facial skeleton.
Botulinum injections for the treatment of bladder symptoms of multiple sclerosis
Authors: Kalsi Vinay , Gonzales Gwen , Popat Roshni , Apostolidis Apostolos , Elneil Sohier , Dasgupta Prokar , Fowler Clare J.
Published: September 2007

Objective

Our objective was to demonstrate the efficacy and impact on quality of life of detrusor injections of botulinum neurotoxin type A in the treatment of bladder dysfunction in patients with multiple sclerosis.

Methods

Forty‐three patients with multiple sclerosis suffering from severe urgency incontinence were treated with detrusor injections of botulinum neurotoxin type A. Data from cystometric assessment of the bladder, voiding diaries, quality‐of‐life questionnaires, and procontinence medication usage were collected before treatment and 4 and 16 weeks after injection. The same data were also collected after repeat treatments.

Results

Highly significant improvements (p < 0.0001) in incontinence episodes and urinary urgency, daytime frequency and nocturia, were the symptomatic reflection of the significant improvements in urodynamically demonstrated bladder function. Although 98% of patients had to perform self‐catheterization after treatment, there were sustained improvements in all quality‐of‐life scores. The mean duration of effect was 9.7 months. Similar results were seen with repeat treatments.

Interpretation

Minimally invasive injections of botulinum neurotoxin type A have been shown to be exceptionally effective in producing a prolonged improvement in urinary continence in patients with multiple sclerosis. This treatment is likely to have a major impact on future management. Ann Neurol 2007
Finger tendon disease in untreated early rheumatoid arthritis: A comparison of ultrasound and magnetic resonance imaging
Authors: Wakefield R. J. , O'Connor P. J. , Conaghan P. G. , Mcgonagle D. , Hensor E. M. A. , Gibbon W. W. , Brown C. , Emery P.
Published: September 2007

Objective

To investigate the frequency and distribution of finger tenosynovitis in patients with early, untreated rheumatoid arthritis (RA) using gray‐scale ultrasound (US) and magnetic resonance imaging (MRI).

Methods

Fifty patients underwent US and MRI of metacarpophalangeal (MCP) joints 2–5. Twenty healthy controls underwent US only. Flexor and extensor involvement was documented for each joint. Intrareader reliability (IRR) was calculated by rereading static images.

Results

Flexor tenosynovitis was found in 57 (28.5%) of 200 joints in 24 (48%) of 50 patients on US compared with 128 (64%) of 200 joints in 41 (82%) of 50 patients on MRI. Periextensor tenosynovitis was found in 14 (7%) joints in 9 (18%) patients on US compared with 80 (40%) joints in 36 (72%) patients on MRI. No controls had imaging tenosynovitis. Using MRI as the gold standard, the sensitivity, specificity, and negative and positive predictive values for US were 0.44, 0.99, 0.49, and 0.98, respectively, for flexor tenosynovitis and 0.15, 0.98, 0.63, and 0.86 for extensor tenosynovitis, respectively. The IRR was 0.85 and 0.8 for US and MRI, respectively. The most frequently involved joints on US and MRI were the second and third MCP joints.

Conclusion

This is the first study to compare US and MRI for the detection of tenosynovitis in the fingers of patients with early untreated RA. Tenosynovitis was found to be common using both modalities, with MRI being more sensitive. A negative US scan does not exclude inflammation and an MRI should be considered. Further work is recommended to standardize definitions and image acquisition for both US and MRI images.
SIMDE: An educational simulator of ILP architectures with dynamic and static scheduling
Authors: Castilla I. , Moreno L. , González C. , Sigut J. , González E.
Published: September 2007

This article presents SIMDE, a cycle‐by‐cycle simulator to support teaching of Instruction‐Level Parallelism (ILP) architectures. The simulator covers dynamic and static instruction scheduling by using a shared structure for both approaches. Dynamic scheduling is illustrated by means of a simple superscalar processor based on Tomasulo's algorithm. A basic Very Long Instruction Word (VLIW) processor has been designed for static scheduling. The simulator is intended as an aid‐tool for teaching theoretical contents in Computer Architecture and Organization courses. The students are provided with an easy‐to‐use common environment to perform different simulations and comparisons between superscalar and VLIW processors. Furthermore, the simulator has been tested by students in a Computer Architecture course in order to assess its real usefulness. © 2007 Wiley Periodicals, Inc. Comput Appl Eng Educ 14: 226–239, 2007; Published online in Wiley InterScience (www.interscience.wiley.com); DOI 10.1002/cae.20154
Structure–Activity Relationship of Prenyl‐Substituted Polyphenols from Artocarpus heterophyllus as Inhibitors of Melanin Biosynthesis in Cultured Melanoma Cells
Authors: Arung Enos Tangke , Shimizu Kuniyoshi , Kondo Ryuichiro
Published: September 2007

A series of prenylated, flavone‐based polyphenols, compounds 1–8, were isolated from the wood of Artocarpus heterophyllus. These compounds, which have previously been shown not to inhibit tyrosinase activity, were found to be active inhibitors of the in vivo melanin biosynthesis in B16 melanoma cells, with little or no cytotoxicity. To clarify the structural requirement for inhibition, some structure–activity relationships were studied, in comparison with related compounds lacking prenyl side chains. Our experiments indicate that both prenyl and OH groups, as well as the type of substitution pattern, are crucial for the inhibition of melanin production in B16 melanoma cells.
A New Amphiphilic Derivative, N‐{[4‐(Lactobionamido)methyl]benzylidene}‐ 1,1‐dimethyl‐2‐(octylsulfanyl)ethylamine N‐Oxide, Has a Protective Effect Against Copper‐Induced Fulminant Hepatitis in Long–Evans Cinnamon Rats at an Extremely Low Concentration Compared with Its Original Form α‐Phenyl‐N‐(tert‐butyl) Nitrone
Authors: Asanuma Taketoshi , Yasui Hironobu , Inanami Osamu , Waki Kenji , Takahashi Momoko , Iizuka Daisuke , Uemura Taketo , Durand Grégory , Polidori Ange , Kon Yasuhiro , Pucci Bernard , Kuwabara Mikinori
Published: September 2007

An amphiphilic α‐phenyl‐N‐(tert‐butyl) nitrone (PBN) derivative, N‐{[4‐(lactobionamido)methyl]benzylidene}‐1,1‐dimethyl‐2‐(octylsulfanyl)ethylamine N‐oxide (LPBNSH), newly synthesized from its original form PBN in hopes of clinical use, was intraperitoneally administered to Long–Evans Cinnamon (LEC) rats every 2 days at the concentrations of 0.1, 0.5, 1.0, and 2.0 mg/kg. We found that LPBNSH protected against copper‐induced hepatitis with jaundice in LEC rats at concentrations of 0.1 and 0.5 mg/kg, which were extremely low compared with that of PBN. It also effectively prevented the loss of body weight, reduced the death rate, and suppressed the increase in serum aspartate aminotransferase and alanine aminotransferase values arising from fulminant hepatitis with jaundice at the same concentrations. Similar results were observed when PBN was administered at the concentration of 150 mg/kg. Immunohistochemical analysis of 8‐hydroxy‐2′‐deoxyguanosine and measurement of thiobarbituric acid‐reactive substances in the liver showed that LPBNSH largely suppressed the formation of these oxidative products at same concentrations. No difference in the abnormal accumulation of copper in the liver between the LPBNSH administered and control groups was observed. From these results, it was concluded that LPBNSH exhibited liver‐protective effects against fulminant hepatitis with jaundice at ca. 1/1000, 500 the molar concentration of PBN and, therefore, was clinically promising.
A New Piperazine‐2,5‐dione from the Marine fungus Gliocladium sp.
Authors: Yao Yao , Tian Li , Cao Jia‐Qing , Pei Yue‐Hu
Published: September 2007

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Carbolithiation of Simple Terminal and Strained Internal Alkenes by the Naphthalene and the Biphenyl Dianion: New Modes of Reactivity of Highly Reduced Organic Species in Solution
Authors: Melero Cristóbal , Guijarro Albert , Baumann Vitus , Pérez‐Jiménez Ángel J. , Yus Miguel
Published: September 2007

Dianions derived from arenes of high reduction potential (biphenyl, naphthalene) and Li(s) can carbometallate propene, isobutene or norbornene among other alkenes, in an intermolecular fashion. This reaction runs at room temperature to afford partially dearomatized alkylated aryl anions that are susceptible to further functionalization by electrophilic capture. This form of reactivity, typical of the arene dianion, deviates from the specific alkali metal‐like reactivity displayed by these complexes, affording regio‐ and in many cases stereo‐controlled products. DFT calculations help to figure out the regiochemical outcome of this reaction, where some of the most inexpensive organic starting materials are involved. (© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2007)