bluuebunny/crossref_metadata_2025_split huggingface dataset:
Selective Irrigation of Paranasal Sinuses in the Treatment of Recalcitrant Chronic Sinusitis
Authors: Moshaver Ali , Velazquez-Villasenor Louis , Lavigne Francois , Witterick Ian J. 
Published: September 2010

Background Chronic rhinosinusitis (CRS) refractory to medical and surgical therapy is a challenging entity to treat. Topical antibiotics and anti-inflammatory drugs have been increasingly used in managing this disorder. The aim of this pilot study is to evaluate the role of maxillary sinus antrostomy tubes (MAST) in selectively irrigating paranasal sinuses with topical antibiotics with anti-inflammatory in treating recalcitrant CRS. A prospective clinical trial was performed at a tertiary referral center. Methods Thirteen patients with failed maximal medical and surgical therapies for chronic sinusitis were enrolled in the study. Endoscopic scores as well as the Sino-Nasal Outcome Test 16 (SNOT-16) scores were obtained before and 3, 8, and 16 weeks after maxillary sinus intubation with MAST. All patients received topical antibiotics with anti-inflammatory medication for 21 days. Results Statistically significant reductions in SNOT-16 and endoscopic scores were found before and after topical irrigations. Both scores continued to improve at the 8th and 16th weeks. Conclusion Selective irrigation of maxillary sinuses using MAST is a viable alternative in treating recalcitrant CRS.
Decreased Rhinovirus Shedding after Intranasal Oxymetazoline Application in Adults with Induced Colds Compared with Intranasal Saline
Authors: Winther Birgit , Buchert Dagobert , Turner Ronald B. , Hendley J. Owen , Tschaikin Marion 
Published: September 2010

Background Intranasal oxymetazoline (OMZ) is used as a decongestant during common colds. Recently, intracellular adhesion molecule (ICAM) 1 receptor expression in vitro has been shown to be diminished by OMZ. ICAM-1 is the major receptor used by rhinovirus to gain entry to human cells. The objective of this study was to assess the effect of OMZ on geometric mean titer of rhinovirus in nasal lavage fluid after rhinovirus inoculation. Methods Volunteers with antibody titers of ≤1:4 to rhinovirus type 39 were enrolled in a randomized, reference-controlled, double-blind study. Beginning 3 hours after intranasal challenge with 100–300 tissue culture infectious dose (TCID)50 of virus, subjects received active 0.05% OMZ (45 μL containing 22.5 μg of OMZ hydrochloride in citrate buffer) or reference control (physiological saline solution [PSS]) three times daily for 5 days. Rhinovirus was detected in fibroblast cultures. Results Geometric mean viral titer (log10) in 34 rhinovirus-infected subjects receiving OMZ was 1.49 on day 2 compared with 2.24 in the 38 infected subjects receiving PSS (p = 0.04). On day 3, the mean titers were 1.45 and 2.08, respectively. Median length of viral shedding was 3.3 days (OMZ) and 3.4 (PSS). Duration of clinical illness was 6.1 days in both groups. Conclusion Topical OMZ decreased viral titer on day 2 during experimental rhinovirus infection in normal volunteers.
Transpalatal Greater Palatine Canal Injection: Radioanatomic Analysis of where to Bend the Needle for Pediatric Sinus Surgery
Authors: McKinney Kibwei A. , Stadler Michael E. , Wong Yu-Tung , Shah Rupali N. , Rose Austin S. , Zdanski Carlton J. , Ebert Charles S. , Wheless Stephen A. , Senior Brent A. , Drake Amelia F. , Zanation Adam M. 
Published: September 2010

Background The greater palatine canal (GPC) local injection is used to limit posterior bleeding during sinus surgery in adults. Given the potential for causing iatrogenic damage to the intraorbital contents, this procedure is not commonly used in the pediatric population. No studies have described the anatomic development of the GPC during facial growth. By using age-stratified radioanatomic analysis, the dimensions of the GPC and the clinical implications are described for pediatric patients. An age-stratified radioanatomic study was performed. Methods High-resolution computed tomography measurements included the thickness of the mucosal plane overlying the GPC, the length of the GPC, and the distance between the base of the pterygopalatine fossa (PPF) and the orbital floor. Mean distance and standard deviation were calculated for each age cohort and compared using the one-way ANOVA test. Results The GPC length correlated directly with patient age. It varied from 9.14 ± 0.11 mm in the youngest age group (<2 years) to 19.36 ± 2.76 mm in adults (18–64 years). The height of the orbit relative to the hard palate approximated the adult dimensions described in the literature by 12–13 years (49.58 ± 1.72 mm). Conclusion These radioanatomic results suggest that the GPC injection described for adult patients may be safely administered to selected pediatric patients. For patients >12 years old, we recommend bending the needle 45° and inserting it 25 mm. For patients 6–12 years old, the needle should be inserted 20 mm to enter into the PPF. In patients <6 years old, the needle may safely be placed 12 mm into the GPC. Each of these descriptions is based on the minimal distance required to effectively access the PPF but with maximal safety in regard to the orbit. Further clinical correlation of these findings is necessary through future investigation.
Nasal Polyps: An Independent Risk Factor for Bronchial Hyperresponsiveness in Patients with Allergic Rhinitis
Authors: Ahn Youngjin , An Soo-Youn , Won Tae-Bin , Kim Jeong-Whun , Lee Chul Hee , Min Yang-Gi , Cho Sang Heon , Park Heung Woo , Koh Young Yull , Kim Sun Sin , Rhee Chae-Seo 
Published: September 2010

Background Many studies were conducted to figure out the relationship between allergic rhinitis (AR) and lower airway diseases. This study was designed to elucidate the clinical parameters that could predict the coexistence of bronchial hyperresponsiveness (BHR) in AR and suggest a guideline for lower airway evaluation in these patients. Methods One hundred seventy-three patients newly diagnosed with AR were evaluated for the lower airway with the methacholine bronchoprovocation test. Results BHR was more prevalent in patients with nasal polyps (p = 0.01), in patients complaining of moderate to severe symptoms (p = 0.023), with higher serum total IgE levels (p = 0.001), and with blood eosinophil count (p = 0.008). No statistically significant difference was observed between intermittent and persistent AR patients (p = 0.364). Blood eosinophil count that could predict BHR was calculated as 320 cells/μL (p = 0.004). Conclusion Instead of a routine lower airway evaluation for all AR patients, we recommend lower airway evaluation for the selected patients with nasal polyps, moderate to severe symptoms, and high blood eosinophil count.
Numerical Simulation of the Effects of Inferior Turbinate Surgery on Nasal Airway Heating Capacity
Authors: Chen Xiao Bing , Lee Heow Pueh , Chong Vincent Fook Hin , Wang De Yun 
Published: September 2010

Background The aim of this study was to evaluate the effects of inferior turbinate surgery on nasal airway heating capacity using computational fluid dynamics (CFD) simulations. Methods Heat transfer simulations were performed for a normal nasal cavity and others with severely enlarged inferior turbinates, before and after three simulated surgical procedures: (1) resection of the lower third free edge of the inferior turbinate, (2) excision of the head of the inferior turbinate, and (3) radical inferior turbinate resection. The models were run with three different environmental temperatures. Results The changes of airflow pattern with the reduction of inferior turbinate affected heat transfer greatly. However, the distribution of wall heat flux showed that the main location for heat exchange was still the anterior region. Under the cold environment, the nasal cavities with the head of inferior turbinate reduction were capable of heating the inspired air to 98.40% of that of the healthy one; however, for the case with lower third of inferior turbinate excised, the temperature was 11.65% lower and for the case with radical inferior turbinate resection, 18.27% lower temperature compared with the healthy nasal cavity. Conclusion The healthy nasal cavity is able to warm up or cool down the inspiratory airflow under different environmental temperature conditions; for the nasal cavities with turbinate surgeries, partial inferior turbinate reduction can still sustain such heating capacity. However, too much or total turbinate resection may impair the normal function of temperature adjustment by nasal mucosa.
Economic Burden of Allergic Rhinitis in Korea
Authors: Kim So Young , Yoon Seok-Jun , Jo Min-Woo , Kim Eun-Jung , Kim Hyun-Jin , Oh In-Hwan 
Published: September 2010

Background Allergic rhinitis is one of most prevalent chronic diseases and results in relatively high medical expenses and economic burden; however, in Korea, studies on economic costs are limited. Therefore, this study investigated the health care use and socioeconomic costs of allergic rhinitis in Korea. Methods This study extracted the insurance claims records from the Korea National Health Insurance Corporation (NHIC) claims database for determining the health care services provided to patients with allergic rhinitis in 2007. The total allergic rhinitis–related cost was the sum of the direct medical care costs, the direct nonmedical care costs, and the indirect cost. The direct medical care consists of the costs paid by insurers and patients, the noncovered service costs, the prescribed drug costs, and the over-the-counter drug costs. Results A total of 4,068,517 people were identified as having allergic rhinitis, yielding a prevalence of 8.4%. The prevalence for children <20 years of age was 13.5% and higher than that of adults. Especially the prevalence of preschool children was higher. The total direct cost was $223.68 million and the lost productivity was estimated to be $49.25 million. Therefore, we approximated the economic burden of allergic rhinitis to be $272.92 million. Conclusion Allergic rhinitis was a frequently occurring disease in the NHIC Claims database and the economic burden has been estimated to be almost $272.92 million. Although this study has some limitations, it is the first study of economic burden in allergic rhinitis representing the entire Korean population.
The Effect of Expandable Polyvinyl Acetate Packing for Preventing Stenosis of the Frontal Sinus Ostium
Authors: Kang Il Gyu , Jung Joo Hyun , Woo Joo Hyun , Cha Heung Eog , Kim Seon Tae 
Published: September 2010

Background The aim of this study was to evaluate the effect of repeated expandable polyvinyl acetate (EPA) packing for preventing stenosis of the frontal sinus ostium after patients undergo functional endoscopic sinus surgery (FESS). Methods A nonrandomized, prospective study of 20 patients with chronic frontal sinusitis was conducted based on the Lund-Mackay scoring system. EPA was packed, for 3 days/week, in total, three times for 3 weeks, into the left frontal sinus ostium right after FESS. For the control, the right side frontal sinus ostium was left unpacked. After 6 months, the patency of the frontal sinus ostium was measured with a ruler under endoscopic guidance and the patency was classified as obstructed, stenotic, or patent according to the size. Results Obstruction developed in the right side in four patients and in the left side in two patients. Stenosis was found in the right side in eight patients and in the left side in one patient. The ostium of the frontal sinus was patent in the right side in 8 patients and patent in the left side in 17 patients. The sizes of the ostia were significantly different between the frontal sinuses on both sides 6 months after FESS (p < 0.05). Conclusion The outcome of repeated EPA packing was favorable in patients undergoing FESS.
The Effect of Macrolides on Myofibroblast Differentiation and Collagen Production in Nasal Polyp–Derived Fibroblasts
Authors: Park Hyo-Hyun , Park Il-Ho , Cho Jung-Sun , Lee You-Mi , Lee Heung-Man 
Published: September 2010

Background Macrolides are known to have anti-inflammatory, immunomodulatory, and tissue reparative effects. The purpose of this study was to determine the effect of macrolides (erythromycin [EM] and roxithromycin [RXM]) on the differentiation of fibroblasts into myofibroblasts and extracellular matrix accumulation in transforming growth factor (TGF) beta1–induced nasal polyp–derived fibroblasts (NPDFs) and to determine if NADPH oxidase (Nox) 4 and reactive oxygen species (ROS) are involved in the aforementioned processes. Methods Nasal polyps of six patients (three women and three men; 32.3 ± 5.2 years of age) were acquired during surgery and NPDFs were isolated from surgical tissues. NPDFs were pretreated with macrolides for 2 hours before differentiation induction by TGF-beta1. The mRNA expressions of alpha-smooth muscle actin (SMA), collagen types I and III, and Nox4 were determined by reverse-transcription–polymerase chain reaction, and the expression of alpha-SMA protein was determined by immunocytochemical staining. The amount of total collagen production was analyzed by SirCol collagen dye-binding assay. ROS activity was measured by nitroblue tetrazolium reduction assay and was visualized by fluorescent microscopy. Results In TGF-beta1–induced NPDFs, EM, and RXM significantly inhibited expressions of alpha-SMA and collagen types I and III mRNA and reduced alpha-SMA and collagen protein levels at concentrations of 5 and 10 μg/mL. EM and RXM also inhibited TGF-β1–induced ROS production and Nox4 mRNA expression at the same concentrations. Conclusion These results suggest the possibility that EM and RXM may play an important role in inhibiting the development of nasal polyps through their antioxidant effect.
Effect of Area of Residence on Patterns of Aeroallergen Sensitization in Atopic Patients
Authors: Mahesh P.A. , Kummeling Ischa , Amrutha D.H. , Vedanthan Pudupakkam K. 
Published: September 2010

Background An association with sensitization to inhaled allergens and allergic rhinitis and asthma has been established. A recent study concluded that the disparity in allergen sensitization might primarily be caused by environmental factors rather than genetic differences. The primary objective was to identify potential differences in sensitization among subjects with the same ethnicity in South India who reside in different environments. Methods Five hundred forty-six patients presenting to a tertiary allergy center with allergic rhinitis and or asthma underwent evaluation using a structured questionnaire, skin-prick testing to common aeroallergens, and spirometry and were categorized according to area of residence. Results The most common allergens causing sensitization were house-dust mite (range, 65–70%), trees (range, 52–56%), and cockroaches (range, 39–53%). There was lower risk of sensitization to cockroach allergens for subjects <21 years old living in suburban (odds ratio [OR], 0.32; 95% confidence interval [CI], 0.12–0.81) and rural environments (OR, 0.33; 95% CI, 0.11–0.96) compared with subjects <21 years old living in urban areas. There was higher risk of sensitization to fungi in subjects <21 years old living in suburban areas (OR, 1.51; 95% CI, 0.60–3.77) and rural environments (OR, 2.71; 95% CI, 0.98–7.48) compared with subjects <21 years old living in urban environments. Conclusion Sensitization patterns are similar in different areas of residence except in younger subjects. Sensitization to fungi was higher in younger subjects from the rural area and cockroach sensitization were higher in younger subjects from urban areas. Sensitization is an important precursor of clinical allergic disease and further studies to unravel the complex gene–environment interactions of aeroallergen sensitization in different environments are needed.
The Intrusion of the Discourse of Economics Into the Clinical Space II: From Excellence to Outcomes
Authors: Plastow Michael 
Published: September 2010

Objective: There has been a recent dissemination of the term ‘excellence’ in psychiatric services without a full appreciation of the origins of its contemporary usage. In recent years, we have also been witness to an increasing emphasis on the language and notions of goals and outcomes in clinical practice, particularly in the public sector. This paper examines the origin and prevalence of the term excellence in both commercial and clinical services and the corresponding preoccupation with strategies and outcomes. Conclusions: It is argued that the contemporary talk of ‘excellence’ has been directly imported from the commercial sector. A closer examination of the ascendency of the use of this term has not been borne out by the results of the companies purported to be ‘excellent’. In a similar vein, the political and corporate talk of strategies and outcomes has been transferred onto the clinical field. Such a movement has occurred primarily through political and financial motivations. A model of outcome-driven treatment is examined as an end result of such a preoccupation with outcomes.
The Intrusion of the Discourse of Economics Into the Clinical Space III: Economic Rationalism and Clinical Effects
Authors: Plastow Michael 
Published: September 2010

Objective: Language has always been a means of imposing political and economic dominance. The ascendancy of the discourse of economics is examined in the context of economic rationalism. Some of the effects of this discourse, both upon our services, as well as upon different modes of conceptualizing the therapeutic relationship, will be examined in this paper. Conclusions: The intensification of the use of terms from economics and management can be dated from the introduction of neo-liberal policies in our Western democracies, but the economic discourse circulates with a life of its own. The use of the language of economics and management has spread generally through our society. Thus, if the economic discourse is the language utilized by some clinicians, it is also to some degree the language adopted by our patients. It is proposed that the extension of the economic discourse into the clinical field is re-shaping the therapeutic relationship with our patients.
Suicide By Couples From the Public Record
Authors: Pridmore Saxby , Reddy Anil 
Published: September 2010

Objective: The aim of this paper was to examine accounts on the public record of suicide by couples, with a view to extending our clinical understanding of such events. Method: A collection of print reports was examined and a web search was conducted. Cases were generally only accepted when the names, ages, locations and method of death of the individuals were provided, along with sufficient detail to convey the rudiments of the social and physical setting. Cases were then arranged into groups and classified using a typology of suicide. Results: Twelve cases were identified which provide valuable insights into the lives of couples who suicide. We found 11 married female-male couples and one female-female couple. A large group (seven couples) was characterized by severe or terminal illness in one or both partners. A small group (three couples) was characterized by serious legal problems. One couple was grieving the loss of an only child, and one example involved a psychotic individual, folie a deux and consequent social stressors. The terminal illness group, the legal difficulties group and the bereaved couple could be classified as ‘Type 3 suicide’ according to the first author's suicide classification. The case involving the psychotic individual and consequent social stressors could be classified as a combination of Type 1 and Type 3 suicide. Conclusion: Reports on the public record of suicide by couples provide valuable insights into the lives of participants, and their suicides could be grouped (terminal illness, legal difficulties, other) and classified using a typology.
Shared Decision-Making: Benefits, Barriers and Current Opportunities for Application
Authors: Simmons Magenta , Hetrick Sarah , Jorm Anthony 
Published: September 2010

Objective: Patient preference and involvement are two important aspects for many psychiatric treatment decisions. Shared decision-making (SDM) has been proposed as the optimal model to include patient preferences and involve patients in such decisions. Decision-making tools called decision aids (DA) are the most common application of SDM. DAs have been demonstrated to increase patients’ knowledge, reduce decisional conflict, and reduce the proportion of patients who are passive in the decision-making process or remain undecided. Unfortunately, there are few DAs available for treatment decisions for psychiatric disorders and implementing SDM can be a challenge for mental health professionals. There are also issues unique to psychiatry related to the development and implementation of DAs that need consideration. Despite this, mental health professionals can and do still employ SDM techniques. This article offers an overview of the skills required to implement a SDM model and the resources currently available. Conclusions: The core features of SDM are advocated for in clinical guidelines, but more resources are needed to ensure these recommendations are implemented in practice. In particular, the benefits of freely available DAs developed according to international standards need to be assessed for suitability and effectiveness.
Borderline Personality Disorder: Exceptions to the Concept of Responsible and Competent
Authors: Little John , Little Bridget 
Published: September 2010

Aim: This article examines whether neurocognitive deficits or age prevents people with borderline personality disorder from being considered responsible and competent. Method: A review of the literature was undertaken relating to borderline personality disorder (BPD), personal responsibility and competency. Result: Neither neurobiological differences nor age automatically disqualify the person with BPD from being responsible and competent for decisions relating to their own life and death. Conclusion: Clinical, legal and ethical literature support this result and thereby re-establishes a basis for the recognition and respect of an individual's dignity.
Implementing a Physical Health Strategy in a Mental Health Service
Authors: Organ Bridget , Nicholson Emma , Castle David 
Published: September 2010

Objective: The aim of this paper is to describe a comprehensive metabolic monitoring strategy within an Australian public mental health service. Methods: Patient physical health was identified as a high priority within the mental health service. A survey of staff attitudes informed the development of metabolic monitoring guidelines and provision of education for clinicians and patients. An audit was subsequently performed to ascertain rates and results of metabolic monitoring, and focus groups helped to understand patient perspectives. Results: Despite significant barriers to the implementation of routine metabolic monitoring from both staff and patient perspectives, our programme delivered on around 60% coverage of routine monitoring of blood glucose and lipids and 54% on weight measurement. Compliance with measurement of waist circumference was much less (7%). Conclusions: To ensure adherence to metabolic monitoring programmes within mental health services, a comprehensive and multifaceted approach is required with ongoing education of both staff and patients.