Nasal airway resistance and symptoms after functional septoplasty: comparison of findings at 9 months and 9 years

Thirty-five patients undergoing a functional septoplasty for nasal obstruction and pathologically high nasal airway resistance were followed up twice, at about 9 months and 9 years postoperatively. The resistance of the preoperatively narrower cavity was reduced at both check-ups, while that of the preoperatively wider cavity, and of the total nose, was lower at the late follow-up than at the early one. Seventy-four per cent of the patients were satisfied with the operation at the first follow-up, and 69% at the later one. Preoperatively, all the patients suffered from nasal obstruction. Postoperatively, at the 9-month follow-up 51% were subjectively free from obstruction, but only 26% were symptom-free at 9 years. Obviously, then, both objective and subjective changes may occur later than 9 months after functional septoplasty.

The natural course of allergic rhinitis during 12 years of follow-up

As symptoms of allergic rhinitis are generally thought to disappear with increasing age, we decided to follow up our allergic rhinitis patients to ascertain whether their disease had regressed or progressed, and whether they had developed respiratory symptoms. At our department, between 1979 and 1982, allergic rhinitis was diagnosed in 108 patients. In 1993, 82 of the patients (40 women, 42 men; mean age 36 years), none of whom had received immunotherapy, answered a questionnaire concerning the status of their allergic rhinitis, and any development of the disease during the interim. Of the 82 patients, one was free of allergic symptoms and 39% had become better; symptoms were unchanged in 39% of cases, and worse in 21%. Six percent had suffered from asthma at presentation, 6% had developed asthma in the interim, and 34% reported other lower airways symptoms. Neither sex nor age at diagnosis was a determinant of the course of allergic rhinitis. Thus, in contrast to findings in other studies, the severity of allergic rhinitis seems to have increased among our patients.

Zur auditiven Bewertung der Stimmqualität

BACKGROUND

For routine clinical purposes, dysphonic voices are assessed perceptually using the GRBAS scale or analogues. For clinical application, the crucial question is the interrater reliability (IRR) of the auditory perceptual assessment of voice quality. Therefore, the IRR of the four point RBH (roughness, breathiness, hoarseness vs overall grade) scale was studied. Other parameters, e.g. validity and intrarater reliability were not considered.

METHODS

A total of 78 patients read a standard text "Der Nordwind und die Sonne". These samples were evaluated by 19 speech and voice therapy students according to the degree of roughness, breathiness and hoarseness. Data were subjected to reliability analysis.

RESULTS

Our data indicate a high IRR with a Cronbach's alpha of 0.94. No single rating of the 19 raters could be omitted without decreasing the IRR.

DISCUSSION

The data indicate that the perceptual assessment of hoarseness for running speech is highly reliable. The application of the RBH scale is suitable for clinical purposes. It should be considered as an outcome measure.

Prevalence of non-allergic nasal complaints in an urban and a rural population in Sweden

By questionnaire, 1469 randomly selected persons between 16 and 82 years of age were asked whether they had suffered from such nasal complaints as obstruction, sneezing and discharge, at least during the previous 6 months. Seventy-five per cent answered the questionnaire, two thirds of whom were city dwellers and one third lived in a rural district. No difference was found between the urban and the rural populations regarding the prevalence of symptoms. Twenty-one per cent suffered from non-allergic nasal complaints, and 5% from allergic nasal complaints. The prevalence of non-allergic nasal complaints was highest in the 20-30-year age group, and lowest in the 50-60-year age group. Contributory factors were of greater importance among the younger individuals than among the more elderly.

Serologic evaluation, efficacy, and safety of a commerical modified-live canine distemper vaccine in domestic ferrets

OBJECTIVE

To determine efficacy and safety of a commercial modified-live canine distemper virus (CDV) vaccine used for prophylaxis in domestic ferrets.

ANIMALS

Sixteen 16-week-old neutered male ferrets.

PROCEDURES

Equal groups of ferrets were inoculated subcutaneously at 16 and 20 weeks of age with saline (0.9% NaCl) solution or a vaccine derived from the Onderstepoort CDV strain and attenuated in a primate cell line. Live virulent CDV was administered to all ferrets intranasally and orally 3 weeks after the second inoculation. Clinical signs and body weights were monitored regularly during the study. Blood samples for serologic examination were drawn prior to each inoculation, before challenge exposure, and 10, 15, and 21 days after exposure. Blood samples for reverse transcriptase polymerase chain reaction (RT-PCR) were obtained 5 days after the first vaccination, and 5, 10, 15, and 21 days after challenge exposure.

RESULTS

After challenge exposure, control ferrets had significantly more clinical signs and weight loss, compared with vaccinates. All vaccinated ferrets survived, whereas all control ferrets died. The RT-PCR assay was successful in detecting CDV in blood and fresh or formalin-fixed tissues from infected ferrets.

CONCLUSIONS AND CLINICAL RELEVANCE

Findings suggest that the vaccine when given SC to domestic ferrets as directed is safe and protective against challenge exposure with virulent CDV. The RT-PCR assay may simplify detection of CDV in fresh and fixed tissues.

Right atrium thrombosis in patients on hemodialysis

Vascular access has been the Achilles heel of hemodialysis for many years, and placement of temporary subclavian and internal jugular vein catheters has been a daily practice for the nephrologist. Now, concern about central vein stenosis, well described with the use of subclavian catheters in end-stage renal disease (ESRD), has prompted the use of internal jugular vein permanent catheters to avoid this complication, so as not to hinder future arteriovenous grafts. Permanent catheter access is not without its own special problems, and we describe here two patients that developed thrombosis of the right atrium while receiving hemodialysis through a permanent internal jugular catheter.

Use of pharmacologic decongestion in the generation of rhinomanometric norms for the nasal airway

It has been reported that nasal decongestion can be more effectively achieved by regulated exercise than by the use of decongestant nose drops. To test this finding, we assessed the relative effectiveness of physical exercise, nose drops, and sprays on 100 consecutive patients with nasal congestion. We found that decongestion was best achieved by spraying the nasal mucosa twice, seven to eight minutes apart, with 0.1% xylometazoline solution (Otrivin; Ciba-Geigy). This study demonstrates that rhinomanometric improvement correlates well with subjective improvement following septoplasty. Rhinomanometric limits for the selection of patients suitable for functional operations of the septum or lateral walls of the nose are presented.

Eight years of follow-up--uvulopalatopharyngoplasty combined with midline glossectomy as a treatment for obstructive sleep apnoea syndrome

In 22 patients with obstructive sleep apnoea, uvulopalatopharyngoplasty was combined with a midline glossectomy of the dorsum of the tongue. The body mass index (BMI) was normal in 13 cases and abnormal in 9. Daytime polysomnography was performed in all cases both preoperatively and 1 year postoperatively. In 16 patients another daytime polysomnography was performed after 8.4 years. The patients also answered a questionnaire 11, 33, 43 and 98 months postoperatively. The apnoea index (AI) was reduced in 82% of cases 12 months postoperatively, being reduced by 50% in 59% of cases and normalized in 32%. After 8.4 years a reduction in the AI was found in 75% and a normal AI in 25% of patients. Subjectively speaking, 95% of the patients were satisfied with the operation at the first follow-up, and the figure was 86% at the fourth follow-up; 64% did not suffer from sleep apnoea at the first follow-up as compared with 46% at the latest follow-up. There was an increase in subjective symptoms postoperatively until the third follow-up. After that the symptoms became stable. There were no immediate postoperative complications, and only minor long-term problems. The duration of postoperative care at the hospital was 2 days. No relationship was found between BMI and outcome.

Global Responses of Il-1β-Primed 3D Tendon Constructs to Treatment with Pulsed Electromagnetic Fields

Tendinopathy is accompanied by a cascade of inflammatory events promoting tendon degeneration. Among various cytokines, interleukin-1β plays a central role in driving catabolic processes, ultimately resulting in the activation of matrix metalloproteinases and a diminished collagen synthesis, both of which promote tendon extracellular matrix degradation. Pulsed electromagnetic field (PEMF) therapy is often used for pain management, osteoarthritis, and delayed wound healing. In vitro PEMF treatment of tendon-derived cells was shown to modulate pro-inflammatory cytokines, potentially limiting their catabolic effects. However, our understanding of the underlying cellular and molecular mechanisms remains limited. We therefore investigated the transcriptome-wide responses of Il-1β-primed rat Achilles tendon cell-derived 3D tendon-like constructs to high-energy PEMF treatment. RNASeq analysis and gene ontology assignment revealed various biological processes to be affected by PEMF, including extracellular matrix remodeling and negative regulation of apoptosis. Further, we show that members of the cytoprotective Il-6/gp130 family and the Il-1β decoy receptor Il1r2 are positively regulated upon PEMF exposure. In conclusion, our results provide fundamental mechanistic insight into the cellular and molecular mode of action of PEMF on tendon cells and can help to optimize treatment protocols for the non-invasive therapy of tendinopathies.

The importance of side difference in nasal obstruction and rhinomanometry: a retrospective correlation of symptoms and rhinomanometry in 1000 patients

OBJECTIVES

The correlation between subjective and objective outcomes of nasal obstruction is still a matter of controversy. The aim of this study was to determine the minimal level of side difference in nasal airway resistance (NAR measured by Broms'v(2)) between the two nasal cavities, which could be discerned subjectively by the patient on a visual analogue scale (VAS). Nasal airway resistance was calculated from rhinomanometric measurements of nasal airflow and transnasal pressure after decongestion of the nasal mucosa.

DESIGN

A retrospective study.

SETTING

ENT department, Vaxjo Central Hospital, Sweden.

PARTICIPANTS

We studied 1000 active anterior rhinomanometries from patients with nasal obstructions.

MAIN OUTCOME MEASURES

We compared the side difference of nasal airway resistance with the side difference of VAS estimated immediately prior to the rhinomanometry. Each measurement was performed after nasal decongestion.

RESULTS

When the difference in nasal airway resistance between the two nasal cavities was larger than 20° (Broms'v(2)) or R(2) > 0.36 Pa/cm(3) /s, we found a significant correlation between side differences of the objective measurement and the subjective assessment (VAS). With a nasal airway resistance side difference over 20°, an additional 20° difference corresponded to a 0.9 centimetre average VAS change. The more obstructed side of the nose could be determined by VAS in 823 (82.3%) of 1000 patients. Yet, 177 (17.7%) patients had a paradoxical sensation of nasal obstruction with the low resistance side of the nose experienced as the most congested side.

CONCLUSION

A significant correlation between the side differences of nasal airway resistance and VAS can serve as a supplement to rhinoscopy in decisions about nasal surgery. This study also showed that in 17.7% of patients, there was a negative correlation between subjective and objective evaluations of nasal airway resistance. But in this group, the nasal airway resistance side difference was mostly under 20°.

High tuberosity healing rate associated with better functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis

Background

Reverse shoulder arthroplasty (RSA) is a common treatment for proximal humeral fractures. (PHF) in the elderly. This study evaluates the functional outcome and the influence of. tuberosity healing (TH) following RSA with 135° humeral inclination and a neutral glenosphere without lateralization for PHFs.

Methods

In this retrospective case series, all patients with an acute PHF treated with primary RSA with 135° humeral inclination and a standard glenosphere without lateralization during a four-year period were followed up. Constant score (CS), patient satisfaction (subjective shoulder value (SSV)), TH and glenoid notching were analyzed.

Results

38 patients with a mean age of 77 ± 8 years were available for follow-up at 34 ± 5 months. The mean adjusted CS was 61 ± 9 points. TH of the greater tuberosity (GT) was 82% and resulted in significantly improved abduction (117° vs. 81°; P < 0.001), forward flexion (139° vs. 99°; p < 0.001), external rotation (28° vs. 10°; p = 0.002), CS (65 vs. 41 points; p < 0.001) and patient satisfaction (SSV 79% vs. 48%; p < 0.001). TH of the LT was 87% without affecting internal rotation or overall outcome. The complication- and revision rate was 5%; implant survival was 100%. Scapular notching occurred in 3 (8%) cases (all grade 1).

Conclusion

RSA with 135° humeral inclination and a standard glenosphere for PHF leads to good functional outcome in combination with a high rate of TH and a low rate of scapular notching. The short-term revision rate is low and the results are predictable and continuous. TH is associated with improved ROM, patient satisfaction and functional outcome.

Objektiv gemessene Stimmlippenschwingungsirregularität vs. subjektiver Eindruck der Rauigkeit

For routine clinical purposes dysphonic voices are assessed using the GRBAS scale or analogues. An objective measurement often includes jitter measurements. Here we raised the question of whether roughness estimates correlate with a computer-aided measurement of the vocal fold cycle irregularity in 78 patients who read a standard text ("Nordwind und Sonne"). The samples were evaluated by 19 speech and voice therapy students according to the degree of roughness. The irregularity index was calculated according to the procedures suggested by Fourcin. Data were subjected to correlation analysis. A significant correlation was found between the irregularity index and the subjective roughness scaling. These data indicate that objective measurements of vibratory cycle irregularity during text reading can be used for clinical purposes in addition to subjective roughness scaling.

Embryonic versus adult myocardium: adenine nucleotide degradation during ischemia

Neonatal myocardium demonstrates better recovery from ischemia than does adult tissue. We tested the hypothesis that developmental differences in adenine nucleotide degradation might facilitate recovery by quantitating depletion of high-energy phosphates in nine-day-old embryonic (n = 9) and 15-month-old adult (n = 14) chicken hearts at 15-, 30-, 45-, and 60-minute intervals of normothermic ischemia in vitro. Nucleotides adenosine triphosphate, adenosine diphosphate, and adenosine monophosphate and nucleosides adenosine, inosine, hypoxanthine, and xanthine were determined by high-performance liquid chromatography. Several observations in metabolite degradative response to ischemia were noted. The embryonic myocardium maintained higher adenosine triphosphate and adenosine monophosphate levels over the course of the investigation than did mature myocardium. Moreover, the adult group showed an increase in diffusible nucleoside pool metabolites. Relative immaturity of enzymes responsible for nucleotide degradation may facilitate postischemic recovery by preserving nondiffusible high-energy phosphate precursors to participate in salvage resynthesis of adenosine triphosphate.

Is there a relationship between the degree of nasal obstruction and snoring?

The possible connection between snoring and nasal obstruction was studied in three groups of adult patients. In group 1, comprising 112 unselected patients, 36% snored, and 50% of the snorers suffered from nasal obstruction. The other two groups consisted of selected patients: group 2 (n = 41) and group 3 (n = 40) all of whom suffered from nasal obstruction. In group 2 nasal airway resistance was normal both before and after decongestant treatment, and in group 3 nasal airway resistance was pathologically high even after decongestant treatment. No difference was found between groups 2 and 3 regarding snoring. Sixty-six per cent in group 2 and 78% in group 3 snored. There was a correlation between snoring and the subjective nasal obstruction, but none between snoring and the degree of nasal obstruction expressed as nasal airway resistance.

VEGF-D-mediated signaling in tendon cells is involved in degenerative processes

Vascular endothelial growth factor (VEGF) signaling is crucial for a large variety of cellular processes, not only related to angiogenesis but also in nonvascular cell types. We have previously shown that controlling angiogenesis by reducing VEGF-A signaling positively affects tendon healing. We now hypothesize that VEGF signaling in non-endothelial cells may contribute to tendon pathologies. By immunohistochemistry we show that VEGFR1, VEGFR2, and VEGFR3 are expressed in murine and human tendon cells in vivo. In a rat Achilles tendon defect model we show that VEGFR1, VEGFR3, and VEGF-D expression are increased after injury. On cultured rat tendon cells we show that VEGF-D stimulates cell proliferation in a dose-dependent manner; the specific VEGFR3 inhibitor SAR131675 reduces cell proliferation and cell migration. Furthermore, activation of VEGFR2 and -3 in tendon-derived cells affects the expression of mRNAs encoding extracellular matrix and matrix remodeling proteins. Using explant model systems, we provide evidence, that VEGFR3 inhibition prevents biomechanical deterioration in rat tail tendon fascicles cultured without load and attenuates matrix damage if exposed to dynamic overload in a bioreactor system. Together, these results suggest a strong role of tendon cell VEGF signaling in mediation of degenerative processes. These findings give novel insight into tendon cell biology and may pave the way for novel treatment options for degenerative tendon diseases.

The spontaneous course of nasal obstruction in patients with normal nasal airway resistance

Sixty-seven patients, candidates for septoplasty in the years 1976-1978 because of nasal obstruction and deviated nasal septum, but not having surgery because their nasal airway resistance was normal, were reviewed in 1982 and again in 1989. Between 1982 and 1989, 6% of the patients became free of their respective nasal complaints, and 18% of their nasal obstruction, the corresponding overall figures for the period between 1976 and 1978, and 1989, being 20 and 36%. In fact, the majority of the patients were suffering from vasomotor rhinitis and because in so many cases nasal obstruction tends to disappear as time goes on, a conservative waiting policy would seem to be an appropriate approach to treatment.

On rhinomanometry in rhinoplasty

Changes in nasal obstruction, nasal airway resistance, and postoperative nose appearance were evaluated in 92 rhinoplasty patients. Fifty-six patients had a deviation of their nose from the midline preoperatively. They were improved according to rhinomanometry whether the rhinoplasty was combined with a functional septoplasty or with a submucous resection. Among the other 36 patients who did not have a deviation of the nose from the midline, 23 had a rhinoplasty combined with a functional septoplasty and 13 had no surgery on the septum at all. Rhinomanometrically, only patients operated on with the combined operation were improved; the rest became worse, even in terms of nasal obstruction. Among 58 patients from both groups with preoperative nasal obstruction, there was agreement for 76 percent between the subjective and rhinomanometric changes. The advantages of giving the rhinomanometric results in a polar coordinate system are discussed.

Paradoxical increase in nasal airway resistance after topical nasal decongestion - does it really exist? A retro- and prospective study

OBJECTIVE

To explore the prevalence and reproducibility of paradoxically increased nasal airway resistance after decongestion of the nasal mucosa as well as to identify patient-related factors associated with it.

DESIGN

Retrospective analysis of all rhinomanometric measurements carried out at one ENT department in Sweden in the time between 1990 and 2010. In the baseline material, 207 of 4435 patients (4.7%) showed a paradoxically increased nasal airway resistance >20%. A follow-up rhinomanometry was performed in patients eligible for the study.

SETTING

Secondary care centre.

PARTICIPANTS

Patients with paradoxically increased nasal airway resistance >20% who returned a complete questionnaire and had not undergone any nasal- or sinus surgery. Thirty-six patients (33-72 years) were eligible for the study.

MAIN OUTCOME MEASURES

All patients answered a questionnaire and underwent rhinoscopy. Nasal airway resistance before and after decongestion with 0.1% xylometazoline hydrochloride was assessed by active anterior rhinomanometry.

RESULTS

Twelve of thirty-six patients (33%) showed a paradoxically increased nasal airway resistance in the follow-up rhinomanometry. No patient-related factors were identified.

CONCLUSION

The results indicate the existence and reproducibility of paradoxically increased nasal airway resistance.

Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort

BACKGROUND

In the presence of cuff tear arthropathy (CTA), joint kinematics is alternated and fracture configuration might be different. The purpose of this study was to identify fracture patterns in patients with advanced CTA to facilitate recognition and treatment.

METHODS

Radiographs and computed tomography scans of all patients undergoing surgical treatment for a proximal humeral fracture (PHF) in our institution during a 5-year period were retrospectively analyzed. Fracture pattern according to the AO-OTA and Resch classification and the presence of CTA were evaluated. Glenoid configuration according to Walch, fatty atrophy of the supraspinatus muscle and the centrum-collum-diaphyseal (CCD) angle were analyzed.

RESULTS

A total of 574 out of 713 patients were included. Twenty-three patients (4%) with a mean age of 82 ± 8 years showed advanced CTA with acetabularization of the acromion (≥ stage 3 according to Hamada/Fukuda). There were exclusively valgus fractures with a mean CCD angle of 158° ± 18°. Patients with CTA ≥ grade 3 had a nearly twofold greater risk (risk ratio: 1.8; confidence interval (CI): 95% 1.6-1.9; p < 0.0001) of sustaining a valgus fracture compared to patients without or with CTA < grade 3. The risk for a tuberosity fracture was nearly twofold greater in patients without or with mild CTA (risk ratio: 1.68; confidence interval (CI): 95% 1.17-2.40; p = 0.0046) compared to those with advanced CTA.

CONCLUSION

In advanced CTA, a predominantly valgus fracture pattern can be observed. In addition, fractures of the greater tuberosity were significantly less frequent and were rarely displaced. Up to date, no classification system for PHF has been developed in the setting of CTA although it might indicate a different treatment, and therefore, recognition is crucial. However, when present, this changes the fracture pattern and ability to treat the fracture as the rotator cuff can no longer be utilized as a means of reducing the fragments.

ITER collective Thomson scattering-Preparing to diagnose fusion-born alpha particles (invited)

The ITER Collective Thomson scattering (CTS) diagnostic will measure the dynamics of fusion-born alpha particles in the burning ITER plasma by scattering a 1 MW 60 GHz gyrotron beam off fast-ion induced fluctuations in the plasma. The diagnostic will have seven measurement volumes across the ITER cross section and will resolve the alpha particle energies in the range from 300 keV to 3.5 MeV; importantly, the CTS diagnostic is the only diagnostic capable of measuring confined alpha particles for energies below ∼1.7 MeV and will also be sensitive to the other fast-ion populations. The temporal resolution is 100 ms, allowing the capture of dynamics on that timescale, and the typical spatial resolution is 10-50 cm. The development and design of the in-vessel and primary parts of the CTS diagnostic has been completed. This marks the beginning of a new phase of preparation to maximize the scientific benefit of the diagnostic, e.g., by investigating the capability to contribute to the determination of the fuel-ion ratio and the bulk ion temperature as well as integrating data analysis with other fast-ion and bulk-ion diagnostics.