In-vitro comparison of hydroxyapatite coatings obtained by cold spray and conventional thermal spray technologies

Hydroxyapatite (HA) coatings onto Ti6Al4V alloy substrates were obtained by several thermal spray technologies: atmospheric plasma spray (APS) and high velocity oxy fuel (HVOF), together with the cold spray (CS) technique. A characterization study has been performed by means of surface and microstructure analyses, as well as biological performance. In-vitro tests were performed with primary human osteoblasts at 1, 7 and 14 days of cell culture on substrates. Cell viability was tested by MTS and LIVE/DEAD assays, cell differentiation by alkaline phosphatase (ALP) quantification, and cell morphology was analyzed by scanning electron microscopy. The HA coatings showed an increase of HA crystallinity from 62,4% to 89%, but also an increase of hydrophilicity from ∼32° to 0°, with the decrease of the operating temperature of the thermal spray techniques (APS > HVOF > CS). Additionally, APS HA coatings showed more surface micro-features than HVOF and CS HA coatings; cells onto APS HA coatings showed faster attachment by acquiring osteoblastic morphology in comparison with the rounded cell morphology observed onto CS HA coatings at 1 day of cell culture. HVOF HA coatings also showed proper cell adherence but did not show extended filopodia as cells onto APS HA coatings. However, at 14 days of cell culture, higher cell proliferation and differentiation was detected on HA coatings with higher crystallinity (HVOF and CS techniques). Cell attachment is suggested to be favoured by surface micro-features but also moderate surface wettability whereas cell proliferation and differentiation is suggested to be highly influenced by HA crystallinity and crystal size.

X-ray microtomographic characterization of highly rough titanium cold gas sprayed coating for identification of effective surfaces for osseointegration

A highly rough titanium coating obtained by Cold Gas Spray (CGS) has been characterized by means of high-resolution 3D microtomography (micro-CT) with the aim to evaluate its open and close porosity for possible use in orthopaedic implants to promote osseointegration. Micro-CT allowed a qualitative and quantitative description of the main features, morphology of the pores and surface roughness of the coating. Several numerical values were obtained to describe size, form and distribution of the closed/inner and open/outer pores. Additionally, surface roughness and open porosity were image-analyzed to find the effective surface for osseointegration.

In-vitro study of hierarchical structures: Anodic oxidation and alkaline treatments onto highly rough titanium cold gas spray coatings for biomedical applications

Hierarchical structures were obtained applying two different nanotexturing surface treatments onto highly rough commercial pure titanium coatings by cold spray: (i) anodic oxidation and (ii) alkaline treatments. An extended surface characterization in terms of topography, composition, and wettability has been performed to understand how those parameters affect to cell response. Primary human osteoblasts extracted from knee were seeded onto the as-sprayed titanium surface before and after the nanotexturing treatments. Cell viability was tested by using MTS and LIVE/DEAD assays, as well as osteoblasts differentiation by alkaline phosphatase (ALP) quantification at 3 and 10 days of cell culture. The combination of micro-/nano-roughness results in a significantly increase of cell proliferation, as well as cell differentiation after 10 days of cell culture in comparison with the non-treated coatings.

Osteoblastic cell response on high-rough titanium coatings by cold spray

Highly rough and porous commercially pure titanium coatings have been directly produced for first time by the cold spray technology, which is a promising technology in front of the vacuum plasma spray for oxygen sensitive materials. The wettability properties as well as the biocompatibility evaluation have been compared to a simply sand blasted Ti6Al4V alloy substrate. Surface topographies were analysed using confocal microscopy. Next, osteoblast morphology (Phalloidin staining), proliferation (MTS assay), and differentiation (alkaline phosphatase activity) were examined along 1, 7 and 14 days of cell culture on the different surfaces. Finally, mineralization by alizarin red staining was quantified at 28 days of cell culture. The contact angle values showed an increased hydrophilic behaviour on the as-sprayed surface with a good correlation to the biological response. A higher cell viability, proliferation and differentiation were obtained for highly rough commercial pure titanium coatings in comparison with sand blasted substrates. Cell morphology was similar in all coatings tested; at 14 days both samples showed extended filopodia. A higher amount of calcium-rich deposits was detected on highly rough surfaces. In summary, in-vitro results showed an increase of biological properties when surface roughness increases.

Real-Time Protein and Cell Binding Measurements on Hydroxyapatite Coatings

Although a lot of in vitro and in vivo assays have been performed during the last few decades years for hydroxyapatite bioactive coatings, there is a lack of exploitation of real-time in vitro interaction measurements. In the present work, real-time interactions for a plasma sprayed hydroxyapatite coating were measured by a Multi-Parametric Surface Plasmon Resonance (MP-SPR), and the results were compared with standard traditional cell viability in vitro assays. MP-SPR is proven to be suitable not only for measurement of molecule-molecule interactions but also molecule-material interaction measurements and cell interaction. Although SPR is extensively utilized in interaction studies, recent research of protein or cell adsorption on hydroxyapatite coatings for prostheses applications was not found. The as-sprayed hydroxyapatite coating resulted in 62.4% of crystalline phase and an average thickness of 24 ± 6 μm. The MP-SPR was used to measure lysozyme protein and human mesenchymal stem cells interaction to the hydroxyapatite coating. A comparison between the standard gold sensor and Hydroxyapatite (HA)-plasma coated sensor denoted a clearly favourable cell attachment on HA coated sensor as a significantly higher signal of cell binding was detected. Moreover, traditional cell viability and proliferation tests showed increased activity with culture time indicating that cells were proliferating on HA coating. Cells show homogeneous distribution and proliferation along the HA surface between one and seven days with no significant mortality. Cells were flattened and spread on rough surfaces from the first day, with increasing cytoplasmatic extensions during the culture time.

In vitro performance of ceramic coatings obtained by high velocity oxy-fuel spray

Hydroxyapatite coatings obtained by plasma-spraying have been used for many years to improve biological performance of bone implants, but several studies have drawn attention to the problems arising from high temperatures and the lack of mechanical properties. In this study, plasma-spraying is substituted by high velocity oxy-fuel (HVOF) spray, with lower temperatures reached, and TiO2 is added in low amounts to hydroxyapatite in order to improve the mechanical properties. Four conditions have been tested to evaluate which are those with better biological properties. Viability and proliferation tests, as well as differentiation assays and morphology observation, are performed with human osteoblast cultures onto the studied coatings. The hydroxyapatite-TiO2 coatings maintain good cell viability and proliferation, especially the cases with higher amorphous phase amount and specific surface, and promote excellent differentiation, with a higher ALP amount for these cases than for polystyrene controls. Observation by SEM corroborates this excellent behaviour. In conclusion, these coatings are a good alternative to those used industrially, and an interesting issue would be improving biological behaviour of the worst cases, which in turn show the better mechanical properties.

Accuracy of acoustic rhinometry versus computed tomography in the evaluation of nasal cavity in patients with nasal polyposis

BACKGROUND

Acoustic rhinometry (AR) accuracy in the diagnosis and follow-up of nasal polyps is as yet unclear. Our objective was to study its accuracy compared with computed tomography (CT) in patients with nasal polyps.

METHODS

We studied 29 patients diagnosed of nasal polyposis by nasal endoscopy. In all patients sinunasal CT-scan, AR and nasal nitric oxide (NO) were assessed. Nasal volumes between 0 and 5 (V(0-5)) and 5 and 9 (V(5-9)) centimetres from nasal inlet were measured with AR and CT-scan, by using Pearson and intraclass correlation coefficient tests.

RESULTS

All patients (29,79% males, mean age 48.2 yr [range 34-61]) had nasal polyps (score 2-3 on Lildholdt classification, score 0-3). Measurements (right plus left sides) were: AR 8.9 +/- 0.8 cm(3) (V(0-5)) and 15.5 +/- 3.6 cm(3)(V(5-9)); CT 6.5 +/- 0.4 cm(3) (V(0-5)) and 6.3 +/- 0.8 cm(3) (V(5-9)). Pearson correlation was r = 0.67 (p < 0.01) for V(0-5) and r = 0.62 (p < 0.05) for V(5-9). Intraclass correlation coefficient test was 0.51 (V(0-5)) and 0.28 (V(5-9)) for consistency; and 0.43 (V(0-5)) and 0.23 (V(5-9)) for absolute agreement. Low levels of NO (312.3 +/- 43.8 ppb) were found and the correlation between NO levels and volumes (V(0-5) or V(0-9)) measured by AR was not statistically significant.

CONCLUSIONS

Compared to CT-scan, AR measurements accurately reflect the geometry of nasal cavity volumes in patients with nasal polyps, with a better assessment in the anterior part of the nasal cavity.

United airways again: high prevalence of rhinosinusitis and nasal polyps in bronchiectasis

BACKGROUND

Although various relationships between the lower and upper airways have been found, the association of bronchiectasis with chronic rhinosinusitis and nasal polyps has not been thoroughly evaluated. This study was undertaken to examine the association of idiopathic and postinfective bronchiectasis with chronic rhinosinusitis and nasal polyposis.

METHODS

In a prospective study, 56 patients with idiopathic and 32 with postinfective bronchiectasis were evaluated for chronic rhinosinusitis and nasal polyposis by using EP(3)OS criteria and assessing: symptoms score, nasal endoscopy, sinonasal and chest CT scan, nasal and lung function and nasal and exhaled NO.

RESULTS

Most bronchiectasis patients (77%) satisfied the EP(3)OS criteria for chronic rhinosinusitis, with anterior (98.5%) and posterior (91%) rhinorrhea and nasal congestion (90%) being the major symptoms. Patients presented maxillary, ethmoidal and ostiomeatal complex occupancy with a total CT score of 8.4 +/- 0.4 (0-24). Using endoscopy, nasal polyps with a moderate score of 1.6 +/- 0.1 (0-3) were found in 25% of patients. Nasal NO was significantly lower in patients with nasal polyposis (347 +/- 62 ppb) than in those without them (683 +/- 76 ppb; P < 0.001), and inversely correlated (R = -0.36; P < 0.01) with the ostiomeatal complex occupancy. In the chest CT scan, patients with chronic rhinosinusitis showed a higher bronchiectasis severity score (7.2 +/- 0.5; P < 0.001) than patients without (3.7 +/- 0.7). The prevalence of chronic rhinosinusitis, nasal polyps and other outcomes were similar in idiopathic and postinfective bronchiectasis.

CONCLUSIONS

The frequent association of chronic rhinosinusitis and nasal polyposis with idiopathic and postinfective BQ supports the united airways concept, and it suggests that the two type of bronchiectasis share common etiopathogenic mechanisms.

Is there an overlap between sudden neurosensorial hearing loss and cardiovascular risk factors?

INTRODUCTION

Sudden sensorineural hearing loss (SSHL) has been proposed as a symptom of underlying vascular problems. The purpose of this work is to evaluate the genetic and acquired risk factors.

METHODS

Ninety-nine patients were tested for the presence of common polymorphisms related to thrombophilia (prothrombin and factor V Leiden) in order to assess genetic risk factors, and several parameters classically associated with vascular disorders (cardiovascular events, brain stroke and antiphospholipid syndrome) were evaluated. Additional assessments of personal and familial history risk factors for vascular disorders were performed in each patient.

RESULTS

Thrombophilia studies did not demonstrate statistically relevant differences between the patients and control group. However, lipidemia profile and directed personal and familial histories showed positive trends for SSHL.

CONCLUSION

The lack of clear relationships between SSHL and other vascular risk factors suggests multicausality as a predominant disease profile. Although preliminary results point at a vascular involvement in SSHL, a long-term prospective study is necessary to demonstrate that SSHL represents an early vascular symptom.

S284 – Impact of Asthma and Atopy on Smell in Nasal Polyposis

Objectives

Nasal polyposis is a chronic inflammatory disease of the nose and paranasal sinuses mucosa that has negative impact on sense of smell. The aim of this study was: 1) to evaluate the sense of smell in patients with severe nasal polyposis; and 2) to evaluate the role of asthma and atopy on the sense of smell.

Methods

We studied 222 patients with severe nasal polyposis (GIII Lildholt) with mean age of 49±14 years. Smell test of BAST-24 has been used for I (I-CN) and V (V-CN) cranial nerves analysing detection, identification, and forced choice. The results were compared with healthy subjects (n=120).

Results

54% were asthmatics and 30% had atopy (positive prick test). All of smell test characteristics were worse than healthy subjects (p<0.05) for: detection (I-CN=37% vs 99%; V-CN=34% vs 98%), identification (I-CN=15% vs 55%; V-CN= 17% vs 59%), and forced choice (I-CN= 18% vs 77%; V-CN= 16% vs 43%). Asthmatics had poorer sense of smell (p<0.05) than non-asthmatics: detection (I-CN=27% vs 48%; V-CN=27% vs 41%), identification (I-CN=11% vs 19%) and forced choice (I-CN= 13% vs 24%). There were no significant differences between aspirin-tolerant and aspirin-sensitive asthmatics or between patients with and without atopy.

Conclusions

These results demonstrated that patients with severe nasal polyposis have an important diminution of sense of smell (detection, identification, and forced choice) and that asthma but not atopy has a negative impact on sense of smell.

Prognostic significance of surgical margins in transoral CO2 laser microsurgery for T1–T4 pharyngo-laryngeal cancers

Histological affected or close margin is an adverse factor in conventional surgery of larynx-hypopharynx cancer. Our objective was to analyze the relevance of the margins in transoral laser microsurgery (TLM). A retrospective study of 357 consecutive patients with cancer of the larynx and hypopharynx (T1-T4) treated with TLM. Three possible margins were considered: tumor free, affected, and uncertain. An affected margin showed marked tumor infiltration. An uncertain margin was defined when the sample was insufficient, when it showed carbonization impeding accurate evaluation, or when tumor cells were less than 2 mm. Margins were free in 254 (71.1%) patients, affected in 64 (17.9%) and uncertain in 39 (10.9%). One hundred and three patients (28.9%) presented tumor relapse. The margins were associated with tumor relapse (P < 0.001), but were not significantly related to the tumor site (P = 0.307), the pT classification (P = 0.183), or the difficulty of surgical exposure (P = 0.427). Distant metastases were found in 4.7% of the patients with free margins, in 7.7% of those with uncertain margins, and in 14.1% with affected margins. These differences were statistically significant (P = 0.028). Tumor involvement of the surgical margin was associated with higher rates of local relapse, distant metastasis and the necessity of salvage surgery, together with a lower specific actuarial survival rate.

[Relation between rhinosinusitis and bronchiectasis]

The nose and lungs have both histological and functional similarities and differences. Sinonasal and bronchial involvement are associated in many diseases. Cystic fibrosis, primary ciliary dyskinesia, Young's syndrome, and alpha-1 antitrypsin deficiency are diseases in which bronchiectasis and rhinosinusitis are both present. This review considers the diseases in which bronchiectasis occurs along with sinonasal manifestations. We propose examining sinonasal disease from a new perspective by observing it in patients with bronchiectasis.

The impact of bronchiectasis associated to sinonasal disease on quality of life

BACKGROUND

Bronchiectasis (BQs) is an uncommon disease with the potential to cause devastating complications. All patients with BQs have cough and chronic sputum production that may have a great impact on patient's quality of life. Upper airway symptoms are also frequent in patients with BQs. Associations between upper and lower airways diseases have been demonstrated in allergic rhinitis and asthma, nasal polyposis and asthma, chronic obstructive lung disease and chronic rhinosinusitis.

OBJECTIVE

(1) To investigate the impact of bronchiectasis and nasal symptoms on quality of life. (2) To evaluate the added impact of nasal polyposis on quality of life in patients with BQs.

METHODS

Sixty patients with bronchiectasis and upper airway symptoms were included. Patients were evaluated for nasal symptoms, nasal polyp size by endoscopy, and quality of life using the SF-36 generic questionnaire.

RESULTS

In comparison with the Spanish general population, patients with BQs had worse scores in all SF-36 domains (P<0.05). Males reported significantly higher quality of life scores on physical functioning and social functioning than females did. Although the age, pulmonary function, presence of nasal polyps, upper airway symptoms, tobacco smoking history, and disease duration was similar between them. Males with BQs had worse quality of life than males from the Spanish general population on body pain, general health, and vitality (P<0.05). Females with BQs had worse quality of life than females from the Spanish general population on physical function, body pain, general health, vitality, social function, and emotional role (P<0.05). Nasal polyps were found in 25 (41.6%) of 60 patients with BQs. No significant differences were observed on quality of life outcomes between patients with BQs with and without nasal polyposis.

CONCLUSION

These results suggest that BQs has a considerable impact on quality of life while nasal polyposis has no additional impact on the quality of life of patients with BQs.

Bulky cervical liposarcoma associated with sleep apnea syndrome

Sarcomas of the head and neck are relatively infrequent tumors. Liposarcomas represent 10-16% of all soft tissue sarcomas and <5% of them arise from the head and neck. The retropharyngeal area is rarely involved. We present the case of a middle-aged male with clinical symptoms of sleep apnea. A fiber-optic examination revealed a soft submucosal lesion compressing the posterior pharyngeal wall, with partial obstruction of the airway tract. CT showed a large heterogeneous prevertebral mass (6 x 20 cm(2)) occupying the posterior mediastinum. A transoral submucosal biopsy was performed. Histological findings were compatible with a low-grade liposarcoma. The mass was removed in monoblock using a classical laterocervical neck incision. The surgical specimen weighed 500 g. After 24 months of follow-up no signs of tumor recurrence or sleep apnea syndrome were noted.

Hyoid and laryngeal chondrosarcomas have different clinicopathologic features

Hyoid chondrosarcomas (CSs) are uncommon cervical tumours with different features compared to laryngeal CSs. Herein we report a hyoid CS in a 36-year-old male and review the literature. Only eight cases of hyoid CS have been reported to date. We have found important differences between hyoid and laryngeal CSs in terms of the age at presentation, gender, clinical symptoms, time before diagnosis, histologic findings and tumour size.

An aesthetic deformity: Madelung's disease

Madelung's disease, also known as benign symmetric lipomatosis, multiple symmetrical lipomatosis or Lanois-Bensaude syndrome, consists of growth of fatty masses predominantly on the face, neck, shoulders, upper thorax and arms. These painless and symmetrical fatty deposits can cause important aesthetic changes in these patients. Middle-aged males are more commonly affected, with an increased prevalence in the Mediterranean area. Currently, the incidence in Italy is 1 in 25,000 males. The aetiology of Madelung's disease remains unknown, although approximately = 60% of affected patients are clinically overweight and there is an intimate association with chronic alcohol abuse. We report an unusual case of Madelung's disease in a 52-year-old male. The fatty deposits were completely resected by means of surgical lipectomy. The patient remains well and disease-free after 12 months of postoperative follow-up.

Inflammatory myofibroblastic tumor in the larynx: clinicopathologic features and histogenesis

Inflammatory myofibroblastic tumor is extremely rare in the larynx and can mimic a malignant process. We present the case of a 62-year-old male who required tracheotomy due to rapidly progressive stridor. Laryngoscopy showed an exophytic, occlusive tumor located in the right true vocal cord. CT showed an expansive mass measuring 2 x2 x1.3 cm3 and occupying the anterior commissure, with glottic progression to the right true vocal cord. The tumor was completely resected with a CO2 laser via a transoral approach. Histologic examination demonstrated extensive ulceration with the presence of granulation tissue. The specimen was mainly composed of spindle cells arranged in a fasciculated pattern with a myxoid background and focal hyalinization. Immunohistochemical studies revealed positivity of spindle cells to vimentin, muscle-specific actin and smooth muscle actin. The patient showed no evidence of disease 24 months after surgery.

Transoral approach to drain streptococcus pneumoniae spinal epidural abscess in an HIV-infected adult

Spinal epidural abscess due to Streptococcus pneumoniae is extremely rare in adults. It typically occurs in the thoracic, lumbar or lumbosacral epidural spaces, and less frequently in the cervical epidural space. The principal causative microbial agent is Staphylococcus aureus, representing 70% of cases, while 1.6% of cases are caused by S. pneumoniae. We report the first case of an HIV-infected patient with a cervical spinal epidural abscess. The patient was a 43-year-old male with pneumococcal bacteremia and a metatarsal abscess. He reported cervical pain with muscle spasm during cephalic flexion and extension, fever and a painful tumefaction on the second metatarsal of the left foot. MRI confirmed that the retropharyngeal abscess extended to the cervical spinal epidural space. Antibiotic therapy with cefotaxime plus vancomycin was initiated and a transoral surgical approach was used to achieve retropharyngeal and local debridement of the metatarsal abscess. Blood and pus cultures were positive for S. pneumoniae. After 4 months of follow-up the patient remained asymptomatic, without clinical or MRI evidence of recurrence.

Orbitoethmoid aneurysmal bone cyst. Case report and literature review

Aneurysmal bone cyst is a benign, vascular, variable growing and expansive lesion that can occur in any part of the skeletal system, but mainly in long bones and vertebrae. We present a case of orbitoethmoid aneurysmal bone cyst in a 62-year-old female presenting epiphora. Nasal endoscopy was normal. Sinus CTscan revealed an expansive mass in the right ethmoid sinus extending and destroying the right lamina papiracea. The tumor was completely resected through paralateral rhinotomy. Histological analysis showed fibrous septa containing multinucleated giant cells and bone tissue surrounding blood vessel lumens, bordered by endothelial cells. These findings are characteristic of aneurysmal bone cysts. After 30 months of postoperative follow-up the patient remains disease-free and asymptomatic.

Nasal manifestations of systemic illnesses

This article is focused on the nasal and sinusal manifestations of systemic diseases, such as infections, immunodeficiencies, chronic multisystemic disorders, inflammatory bowel diseases, deposition diseases, hematologic diseases, respiratory diseases, and smell and taste disorders. A concise review of some of the systemic diseases that commonly present complaints in the nose and paranasal sinuses, including their prevalence, sinonasal manifestations, diagnosis, and treatment, is provided.

Clinical and epidemiological study of vertigo at an outpatient clinic

OBJECTIVES

The main goal of this study was to set up a database of vertigo patients that could serve as a reference for other ENT services treating these pathologies. We present a clinical and epidemiological study of vertigo in an ENT outpatient clinic in 2001 and describe our diagnosis protocol.

MATERIAL AND METHODS

This was a prospective study of 591 patients (18% of the total number of 3283 first visits) controlled and treated at the ENT service of the Hospital Clinic in Barcelona. The main variables studied were sex, age, clinical characteristics and the results of physical and basic instrumental examinations.

RESULTS

After obtaining a clinical history and performing a physical examination, pure-tone audiometry, impedance audiometry and electronystagmography, 394 patients were discharged with a medical report, diagnosis and prescription for treatment. The other 197 patients whom the standard examination was unable to diagnose were referred to a multidisciplinary committee for re-evaluation.

CONCLUSION

A correct diagnosis is essential to ensure adequate treatment and attain an acceptable balance between cost and effectiveness.

Extranodal lymphoma originating from mucosa-associated lymphoid tissue of the nasopharynx

Non-Hodgkin's lymphoma originating from mucosa-associated lymphoid tissue has been connected with autoimmune disease. These tumours often arise in gastric mucosa and are extremely rare in airway mucosa. Three cases of mucosa-associated lymphoid tissue lymphoma in the cavum have been reported in the literature. A 52-year-old male with rheumatoid arthritis presented with an 8-month history of nasal obstruction and recurrent nasal blood discharge. On physical examination a bulky mass was observed in the nasopharynx. CT demonstrated a soft tissue lesion in the nasopharynx without bone destruction. MRI showed a contrast-enhanced mass with extension to the left pterygoid muscle. Biopsy revealed a low-grade B-cell lymphoid tumour of the marginal zone. The patient received six cycles of cyclophosphamide, vincristine and prednisone with adriamycin treatment, together with intracranial methrotrexate as a prophylactic measure. After 48 months of follow-up there was no evidence of disease and a control MRI scan was normal. The prognosis of this type of tumour is unpredictable and there are too few cases to enable definitive conclusions to be drawn.

Plexiform ameloblastoma presenting as a sinonasal tumor

Ameloblastomas are the most frequent odontogenic tumours, accounting for 1% of all tumours of the maxilla and mandible. Sinonasal ameloblastomas are most common between the ages of 55 and 65, and mandibular ameloblastomas between 40 and 50. Incidence is higher in males than in females, and there are no differences between races. These locally aggressive tumours originate in the mandible in 80% of cases and in the maxilla in 15-20%. We report an unusual primary nasosinusal ameloblastoma presented in a 68-year-old male. The tumour was completely resected by (para)lateral rhinotomy and treated with postoperative radiotherapy. Histological analysis demonstrated a plexiform ameloblastoma. The patient remains well without disease after 50 months of postoperative follow-up.