Sphenomaxillary Plate: Landmine or Landmark?

OBJECTIVES

Sphenomaxillary plate (SMP) is an inconstant bony septum separating the maxillary and sphenoid sinuses. Neglecting the SMP during endoscopic sinus surgery may lead to mistaking the sphenoid sinus for the posterior ethmoid cell with potentially dangerous consequences. However, its proper identification may allow planned sphenoidotomy through the posterior wall of the maxillary sinus or to enlarge transnasal or transethmoidal sphenoidotomy. The aim of this study was to evaluate (1) the incidence and morphology of the SMP and (2) possibility and safety of trans-SMP sphenoidotomy.

METHODS

In the radioanatomical part of the study multiplanar reconstruction analysis of 117 consecutive paranasal sinus CT scans was conducted. In the clinical part of the research, trans-SMP sphenoidotomy was performed in consecutive patients operated on for chronic rhinosinusitis.

RESULTS

The SMP was found in 25% of sides (34% of patients). It was constantly located superolateral to the posterior insertion of the middle turbinate. The SMP formed the prominence on the posterior wall of the maxillary sinus that could be identified using volume rendering in 11% of sides (19% of patients). 30 trans-SMP sphenoidotomies were performed in 18 patients. The SMP prominence was identified in 15 sides. In absence of SMP prominence, identification of the SMP was still possible using other anatomical landmarks.

CONCLUSIONS

The SMP is present in over 30% Caucasian subjects at least on one side. Sphenoidotomy through the SMP is feasible and safe.

What do physiotherapists and physiotherapy students know about autonomic dysreflexia?

CONTEXT/OBJECTIVE

Autonomic dysreflexia (AD) is an emergency condition typical for individuals with spinal cord injury (SCI). Adequate health professionals' knowledge of AD is important for the effective and safe rehabilitation of persons with SCI. The purpose of the study is to assess the knowledge of AD in undergraduate and postgraduate physiotherapists. The data gained will be useful for better addressing of AD in clinical practice.

DESIGN

An observational study.

SETTING

Rehabilitation College in Warsaw, Medical University of Warsaw, Poland.

PARTICIPANTS

52 undergraduate and 68 postgraduate physiotherapists.

INTERVENTION

AD knowledge testing.

OUTCOME MEASURES

A test assessing knowledge of causality and consequences of AD created at the Medical University of Warsaw.

RESULTS

No significant differences in test scores between under- and postgraduates were found (P = 0.09). Higher scores were noted in physiotherapy masters as compared to bachelors (P = 0.01), in participants who have an in-patient practice (P = 0.04), a practice longer than 5 years (P = 0.02) and those who see patients with SCI more frequently (P = 0.01). A self-assessed knowledge of AD was admitted as poor or none by 96.2% of undergraduates and 86.8% of postgraduates.

CONCLUSION

In the studied population the knowledge of causality and consequences of AD presented by undergraduate and postgraduate physiotherapists was low. Lower test scores were associated with a lower level of professional education achieved, having an outpatient practice only and having fewer patients with spinal cord injury. Efforts should be made to improve undergraduate and postgraduate education on AD of physiotherapists.

Three-dimensional computed tomography analysis of frontoethmoidal cells: A critical evaluation of the International Frontal Sinus Anatomy Classification (IFAC)

OBJECTIVES

Two major classifications of frontoethmoidal cells, Lee and Kuhn and the IFAC (International Frontal Sinus Anatomy Classification), distinguish anterior, posterior and medial cells. The European anatomical position paper includes also lateral cells. According to the IFAC, anterior cells push the frontal sinus drainage pathway (FSDP) medially, posteriorly or posteromedially. Posterior cells push the FSDP anteriorly. The only medial cell, pushing the FSDP laterally is the frontal septal cell, which is attached to or located in the interfrontal sinus septum. The aim of this study was to verify the IFAC and characterise cells, which are inconsistent with this classification.

DESIGN

A radioanatomic analysis.

SETTING

Tertiary university hospital.

PARTICIPANTS

One hundred and three Caucasian adult patients with no inflammatory changes in paranasal sinuses CT.

MAIN OUTCOMES MEASURE

Results of assessment of multiplanar reconstruction of thin slice CT.

RESULTS

Two types of cells that cannot be classified using the IFAC were found: (a) Lateral cells extending between the skull base and the anterior buttress, pushing the FSDP anteromedially or medially, present in 34 (16.5%) of the sides, (b) Paramedian cells: medially based, not adjacent to the interfrontal septum, pushing the FSDP laterally and posteriorly, present in 33 (16%) of sides. Suprabulla cells and suprabulla frontal cells were found to push the FSDP in directions other than anterior 28% and 31% of the time respectively.

CONCLUSIONS

Neglecting lateral and paramedian cells may lead to inconsistent results between radioanatomical studies and impede communication between surgeons. They should be included in existing classifications of frontoethmoidal cells.

The Effect of Anti-aging Peptides on Mechanical and Biological Properties of HaCaT Keratinocytes

Atomic force microscopy (AFM) and fluorescence microscopy was applied to determine the influence of the anti-aging peptides on the morphology and the mechanical properties of keratinocytes. Immortalized human keratinocytes (HaCaT) were treated with two anti-aging bioactive peptides: Acetyl Tetrapeptide-2 and Acetyl Hexapeptide-50 (Lipotec). The AFM measurement of the keratinocyte stiffness were carried after 48 h exposure at an indentation depth of 200 nm. AFM analysis showed increase of the cell stiffness for cells treated with Acetyl Tetrapeptide-2 (P1) in concentration range. Acetyl Hexapeptide-50 (P2) at concentration of 0.05 µg/ml also increased the stiffness of HaCaT cells but at higher concentrations 0.5 and 5 µg/ml cell stiffness was lower as compared to untreated control. Fluorescence microscopy revealed remodeling of actin filaments dependent on the concentration of P2 peptide. The mechanical response of HaCaT cells treated with P2 peptide corresponds to change of transcription level of ACTN1 and SOD2 which activity was expected to be modulated by P2 treatment.

The effect of polymeric membrane surface on HaCaT cell properties

The control of the surface properties is an important issue for applicability of polymer membranes interacting with cells. In this work, the influence of surface roughness and stiffness of two polymer membranes on viability and mechanical properties of keratinocytes was studied. Terpolimer polyglicolide, polycaprolactone and polylactide, (PGA-PCL-PLA) and copolymer polycaprolactone, polyglicolide (PGA-PCL) substrates were used for membranes fabrication. Surface modification - the hydrolysis of the obtained membranes was carried out. The analysis of membranes' surface properties revealed that RMS surface roughness and roughness factor of PGA-PCL-PLA membrane decreased after hydrolysis while its stiffness increased. In contrast, the PGA-PCL membrane stiffness was only slightly affected by NaOH treatment. Immortalized human keratinocytes (HaCaT) were grown under standard conditions on the surface of the studied membranes and characterized by means of atomic force microscopy and fluorescence microcopy. The results showed the substrate-dependent effect on cells' properties.

Measurement of the inflammatory response in the early postoperative period after hip and knee arthroplasty

BACKGROUND

The aim of this study was to identify an inflammatory marker with fast and predictable kinetics to enable future discrimination between normal postoperative inflammation and potential infection after total hip and knee arthroplasty cases.

METHODS

Changes in serum levels of C-reactive protein (CRP), interleukins (IL) 1β, 6 and 8 and NT-proCNP peptide were measured before and during first 5 postoperative days in 100 patients undergoing total hip or knee arthroplasty. We also compared two methods to describe the magnitude of inflammation--applying separate two sample tests at each time point, and summary measures--area under the curve (AUC).

RESULTS

IL-6 showed a similar kinetics pattern to the CRP in response to surgical trauma. Significantly greater level changes in all markers but NT-proCNP were observed in knee patients. Persisting high levels of CRP, but not other markers, were observed in obese hip patients. IL-6 was found to be an adjunct to routine CRP use.

CONCLUSIONS

IL-6 has faster kinetics and is less influenced by patient weight, therefore it seems to be more useful in clinical practice. Summary measures describe the inflammatory response well and are easier to analyze than multiple analyses of single time points.