RESUMEN
The current article is an experience report on the establishment of an ENT clinic in Asmara/Eritrea and the organization of regular work stays for the further education of local colleagues. Objectives of the project are content and structural support for self-help and thus achievement of sustainable development aid, which benefits both the medical development of the country and the care of the local patients.
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Atención a la Salud , Eritrea , HumanosRESUMEN
BACKGROUND: An appropriate in-vitro model of the human nasal mucosa was developed, which allowed to measure the influence of different pharmaceutical substances on the ciliary beat frequency (CBF) under standardized conditions. METHOD: The present study describes the effect of the alpha-sympathomimetic drugs naphazolin, xylometazolin and oxymetazolin as pure substances and the preservative Benzalkonium chloride in rising concentrations on the CBF. For these investigations human cells of the human nasal mucosa were cultured, which exhibited a high constancy during the equilibration measurements over at least 200 minutes. RESULTS: The alpha-sympathomimetic drugs oxymetazoline in the concentration of 0.01% and 0.001% as well as naphazoline within all three concentrations did not show any change of the CBF. Whereas xylometazoline in the concentration of 0.1% caused a high-significant decrease of the CBF. This decrease of the CBF was however partially reversible after rinsing out. Oxymetazolin showed likewise a significant decrease of the CBF in the concentration of 0.1%. This effect however was not reversible after rinsing out with substrate-free medium, but on the contrary showed up a further decrease of CBF. The preservative benzalkonium chloride effected an irreversible ciliostatic activity already in the concentration of 0.005%. CONCLUSIONS: From the three investigated alpha-sympathomimetic drugs only naphazoline in all measured concentrations did not show any toxic effect. With regard to its therapeutic application this drug in the concentrations 0.001%-0.1% should be preferred to all other alpha-sympathomimetic drugs. Oxymetazoline in the concentration of 0.01% and 0.001% had no toxic effect as well. It however caused an irreversible damage to the cilia in the concentration of 0.1%. This should be considered for the application of rhinological drugs especially in children. The same attention is demanded for xylometazoline, causing a high significant release of CBF in the concentration of 0.1%, which is only partially reversible. Due to the results of this study it has strongly to be advised against the use of all rhinological drugs containing the preservative benzalkonium chloride.
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Agonistas alfa-Adrenérgicos/farmacología , Antiinfecciosos Locales/farmacología , Compuestos de Benzalconio/farmacología , Depuración Mucociliar/efectos de los fármacos , Mucosa Nasal/efectos de los fármacos , Cilios/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Diseño de Equipo , Análisis de Fourier , Humanos , Imidazoles/farmacología , Técnicas In Vitro , Microscopía Electrónica de Rastreo , Microscopía de Contraste de Fase/instrumentación , Nafazolina , Oximetazolina/farmacología , Procesamiento de Señales Asistido por Computador/instrumentación , Programas Informáticos , Grabación en Video/instrumentaciónRESUMEN
AIM: Assessment of the clinical value of (18)F-FDG-PET for detection of recurrent head and neck cancer, local lymph node involvement and distant metastases comparing a qualitative visual with a semiquantitative analysis (SUV values). PATIENTS, METHODS: Retrospective evaluation of 73 (18)F-FDG PET studies in 55 patients by use of a four-step qualitative visual grading system and calculation of standard uptake values in pathological lesions. Calculation of SUV values in normal regions for generating a map of physiological (18)F-FDG distribution. Correlation to histopathological findings and clinical follow-up. RESULTS: 1. Qualitative visual analysis of (18)F-FDG PET studies: a) local recurrence sensitivity 79%, specificity 97%, positive predictive value 95%, negative predictive value 85%, and diagnostic accuracy 89%; b) local metastatic lymph nodes 100%, 95%, 85%, 100%, 96%; c) distant metastases 100%, 98%, 86%, 100%, 98%, respectively. 2. Semiquantitative analysis had only little incremental, non-significant value in comparison to qualitative visual analysis for the detection of a local recurrence in two patients: a) local recurrence: sensitivity 83%, specificity 100%, positive predictive value 100%, negative predictive value 88%, and diagnostic accuracy 93%; b) local metastatic lymph nodes or c) distant metastases did not change in comparison to qualitative visual analysis. CONCLUSION: (18)F-FDG PET is an effective tool for re-staging of patients with suspected recurrence after therapy for head and neck cancer.
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Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Metástasis Linfática/diagnóstico por imagen , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Femenino , Fluorodesoxiglucosa F18/farmacocinética , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Recurrencia Local de Neoplasia , Cintigrafía , Radiofármacos/farmacocinética , Reproducibilidad de los Resultados , Estudios Retrospectivos , Programas Informáticos , Distribución Tisular , Resultado del TratamientoRESUMEN
BACKGROUND: Extratemporal processes are rare causes of peripheral facial palsy. Only 17 cases of facial palsy in association with a suppurative or necrotic parotitis are reported in the literature. PATIENT AND RESULTS: We present a case of a peripheral facial palsy initiated by an infection of a epidermoid cyst, which consecutively involved the whole parotid gland. After abscess drainage and antibiotic therapy the inflammation process receded. The palsy persisted over a period of 4 weeks but improved completely. CONCLUSIONS: As the facial nerve was not enclosed by the abscess formation the palsy must have been caused indirectly. It may be assumed the inflammation spread into the Fallopian canal through the stylomastoid foramen and caused a metabolic imbalance similar to the supposed vicious circle for Bell's palsy. Due to the relapse tendency of inflammations of epidermoid cysts it is recommended to remove the entire cyst.
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Quiste Epidérmico/complicaciones , Parálisis Facial/etiología , Enfermedades de las Parótidas/complicaciones , Infecciones Estafilocócicas/complicaciones , Adulto , Antibacterianos/uso terapéutico , Quiste Epidérmico/patología , Femenino , Estudios de Seguimiento , Humanos , Enfermedades de las Parótidas/tratamiento farmacológico , Enfermedades de las Parótidas/patología , Glándula Parótida/patología , Parotiditis/tratamiento farmacológico , Parotiditis/etiología , Recurrencia , Infecciones Estafilocócicas/tratamiento farmacológico , Factores de TiempoRESUMEN
OBJECTIVES: Frontal sinus surgery is a challenge to those involved in the treatment of recurrent frontal sinusitis. The purpose of this report is to describe the technique and to present the results of a combined endoscopic and external approach to the frontal sinus (rhino-frontal sinuseptotomy [RFS]). MATERIAL: RFS was performed in 45 patients by the author; 41 of these patients had a follow-up over 12 months and were included in this series. Indications for RFS were severe chronic frontal sinusitis (n = 23), mucoceles (n = 12), in two cases each with osteoma, inverting papilloma, and malignant tumors of the frontal sinus, respectively. The surgical technique is started with an external approach according to Jansen-Ritter and includes the resection of the interfrontal septum, partial resection of the nasal septum, bilateral subtotal resection of the middle turbinates, bilateral endoscopic ethmoidectomy, and resection of the frontal sinus floor. The nasofrontal communication is epithelialized with free mucosal grafts and fixed with fibrin clue. RESULTS: After a mean follow-up of 62 months, 40 patients (98%) had a widely patent epithelialized nasofrontal communication. Ninety-one percent of the patients with chronic frontal sinusitis or mucoceles noted complete relief of their frontal discomfort within 1 week after RFS. No patient required revision surgery of the nasofrontal outflow tract after RFS. Only one severe complication was recognized (cerebrospinal fluid leakage). CONCLUSION: The results reported here with the RFS technique are superior to those reported on external procedures and endoscopic drill-out procedures. The key to successful management is the creation of a large nasofrontal communication, and direct epithelialization with free mucosal grafts obtained from the septum and turbinates.
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Seno Frontal/cirugía , Sinusitis Frontal/cirugía , Mucocele/cirugía , Tabique Nasal/cirugía , Neoplasias de los Senos Paranasales/cirugía , Adolescente , Adulto , Anciano , Endoscopía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pólipos Nasales/cirugía , Osteoma/cirugía , Papiloma Invertido/cirugía , Recurrencia , Reoperación , Factores de Tiempo , Resultado del Tratamiento , Cornetes Nasales/cirugíaRESUMEN
Vascular endothelial growth factor (VEGF) is known as an endothelial cell-specific mitogen. There are no reports concerning the presence of VEGF in the inner ear. To gain information, immunohistochemical analysis using specific antibodies to VEGF and to both known VEGF receptors Flt-1 and KDR/Flk-1 was performed on paraffin-sectioned temporal bones from five guinea pigs. Immunoreactivity of VEGF, Flt-1 and KDR/Flk-1 was detectable in spiral ganglion cells. VEGF could also be found in the endothelium of blood vessels, in the spiral ligament and in the organ of Corti. Flt-1 was found in the limbus epithelium, in all supporting cells of the organ of Corti, in Claudius cells, cells of the sulcus and in the spiral ligament. Flk-1 could be detected in some supporting cells of the organ of Corti (inner pillar cells and Deiters' cells). Immunoreactivity to Flk-1 was also found in endothelium of blood vessels and in the spiral ligament. Hair cells showed VEGF immunostaining, but did not contain staining to Flt-1 nor Flk-1. In the stria vascularis any immunoreactivity to all used VEGF and VEGF receptor antibodies could not be detected. The findings were supported by Western blot analysis on inner ear tissues and ovaries from guinea pigs. We may conclude that the growth factor VEGF and both receptors participate in cochlear physiology.
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Cóclea/metabolismo , Factores de Crecimiento Endotelial/metabolismo , Linfocinas/metabolismo , Proteínas Proto-Oncogénicas/metabolismo , Proteínas Tirosina Quinasas Receptoras/metabolismo , Receptores de Factores de Crecimiento/metabolismo , Animales , Femenino , Cobayas , Inmunohistoquímica , Órgano Espiral/metabolismo , Receptores de Factores de Crecimiento Endotelial Vascular , Ganglio Espiral de la Cóclea/metabolismo , Distribución Tisular , Factor A de Crecimiento Endotelial Vascular , Receptor 1 de Factores de Crecimiento Endotelial Vascular , Factores de Crecimiento Endotelial VascularRESUMEN
OBJECTIVE: To analyze the value of electromyography in predicting recovery from acute idiopathic facial nerve paralysis. STUDY DESIGN: Retrospective case-series review. SETTING: University-based hospital department of otorhinolaryngology/head neck surgery. PATIENTS: Three hundred fifty-five patients with sudden facial paralysis of unknown cause (Bell's palsy). INTERVENTION: Treatment consisted uniformly of high-dose prednisolone, dextran, and pentoxifylline. Prognostication was based on electromyography performed not earlier than 10 to 14 days after the onset of palsy. The findings were classified according to Seddon into neurapraxia and axonotmesis/ neurotmesis. There is an inherent statement on prognosis in this classification because neurapraxia is presumed to recover completely within 8 to 12 weeks, whereas axonotmesis is most likely to be followed by sequelae. MAIN OUTCOME MEASURES: Facial nerve function after 6 months. RESULTS: Complete recovery was predicted correctly in 92.4% of cases. For the relatively rare and therefore principally more difficult predictable event defective recovery prognosis was still accurate in 80.8%. CONCLUSION: The detection of spontaneous fibrillation in needle electromyography is a reliable sign predicting unfavorable outcome. An accuracy of 80.8% for predicting unfavorable outcome may be sufficient to advise patients what to expect in the course of their facial nerve disorder. However, it seems dubious to build a decision about surgical intervention on such a test, because in the process, unnecessary surgery would be accepted for as much as one fifth of the patient population.
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Parálisis Facial/diagnóstico , Enfermedad Aguda , Antiinflamatorios/uso terapéutico , Anticoagulantes/uso terapéutico , Dextranos/uso terapéutico , Electromiografía/métodos , Músculos Faciales/inervación , Músculos Faciales/fisiopatología , Nervio Facial/fisiopatología , Parálisis Facial/tratamiento farmacológico , Parálisis Facial/fisiopatología , Fármacos Hematológicos/uso terapéutico , Humanos , Neuronas Motoras/fisiología , Conducción Nerviosa/fisiología , Pentoxifilina/uso terapéutico , Valor Predictivo de las Pruebas , Prednisolona/uso terapéutico , Estudios RetrospectivosRESUMEN
Chewing, swallowing, breathing, and vocalization in mammals require precise coordination of tongue movements with concomitant activities of the mimetic muscles. The neuroanatomic basis for this oro-facial coordination is not yet fully understood. After the stereotaxic microinjection of retrograde and anterograde neuronal tracers (biotin-dextran, Fluoro-Ruby, Fluoro-Emerald, and Fluoro-Gold) into the facial and hypoglossal nuclei of the rat, we report here a direct bilateral projection of hypoglossal internuclear interneurons onto facial motoneurons. We also confirm the existence of a small pool of neurons in the dorsal part of the brainstem reticular formation that project ipsilaterally to both facial and hypoglossal nuclei. For precise tracer injections, both motor nuclei were located and identified by the electrical antidromic activation of their constituent motoneurons. Injections of retrograde tracers into the facial nucleus consistently labeled neurons in the hypoglossal nucleus. These neurons prevalently lay in the ipsilateral side, were small in size, and, like classic intrinsic hypoglossal local-circuit interneurons, had several thin dendrites. Reverse experiments - injections of anterograde tracers into the hypoglossal nucleus - labeled fine varicose nerve fiber terminals in the facial nucleus. These fiber terminals were concentrated in the intermediate subdivision of the facial nucleus, with a strong ipsilateral prevalence. Double injections of different tracers into the facial and the hypoglossal nuclei revealed a small, but constant, number of double-labeled neurons located predominantly ipsilateral in the caudal brainstem reticular formation. Hypoglossal internuclear interneurons projecting to the facial nucleus, as well as those neurons of the parvocellular reticular formation that project to both facial and hypoglossal nuclei, could be involved in oro-facial coordination.
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Músculos Faciales/fisiología , Nervio Hipogloso/fisiología , Interneuronas/fisiología , Boca/fisiología , Ratas/fisiología , Formación Reticular/fisiología , Animales , Mapeo Encefálico , Tronco Encefálico/fisiología , Nervio Facial/fisiología , Femenino , Nervio Hipogloso/citología , Ratas Wistar , Formación Reticular/citologíaRESUMEN
OBJECTIVE: Malformations of the first branchial cleft are uncommon and only sporadically reported in the literature. They may present as inflammatory openings on the neck, bland cysts or fistula associated with the external auditory canal. In this retrospective study, clinical features and anatomical relationships are described in three pediatric cases. Therapeutical guidelines for surgical management of first branchial cleft anomalies are discussed. PATIENTS: Between 1997 and 1999 three patients aged 9 months, 2 and 7 years with first branchial cleft anomalies were included in this study. All patients were treated surgically, wide exposure and superficial parotidectomy was necessary for complete removal in two of three cases. RESULTS: Exploring patients histories revealed previous infections with repeated incision and drainage procedures as well as inadequate operative resections. Clinically, purulent drainage from the ear, swelling in the parotid area and abscess formation with persistent drainage after incision in the neck or parotid area were noted. CONCLUSIONS: From our case series two of three patients underwent inadequate incision and drainage procedures to combat infection followed by scar tissue formation. Because of the variable relation to the facial nerve this led to difficulties in identifying and protecting the nerve during definite surgery. Management of first branchial cleft anomalies must include the facilities to achieve ear surgery and superficial parotidectomy including facial nerve exposure.
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Región Branquial/anomalías , Conducto Auditivo Externo/anomalías , Niño , Preescolar , Femenino , Humanos , Lactante , MasculinoRESUMEN
OBJECTIVE: To analyze the value of electromyography in predicting recovery from acute neurogenic vocal fold paralysis. STUDY DESIGN: Prospective case series. SETTING: University-based hospital of otorhinolaryngology-head and neck surgery. PATIENTS: Ninety-eight patients (56 women, with a mean age of 62.2 years; 42 men, with a mean age of 39.8 years) with 111 paralyzed vocal folds. The causes were varied, with thyroid surgery (53 cases) and idiopathic palsy (18 cases) being the predominant factors. INTERVENTION: Prognostication was based on electromyography performed no earlier than 14 days after onset of palsy. Findings were classified as neurapraxy, axonotmesis, and neurotmesis. Prognosis is inherent in this classification, since neurapraxy is presumed to resolve completely within 8 to 12 weeks, whereas axonotmesis is most likely to be followed by impaired vocal fold mobility. MAIN OUTCOME MEASURES: Vocal fold mobility after 6 months. RESULTS: In 102 vocal folds, some palsy of various degree persisted after 6 months. Free mobility of the paralyzed vocal fold was restored in 9 cases. By means of laryngeal electromyography, defective recovery, defined as absence of completely free vocal fold mobility, was predicted correctly in 94.4% of cases (68/72). For complete recovery, prognosis was accurate in only 12.8% of cases (5/39). CONCLUSIONS: The detection of neural degeneration by laryngeal electromyography allows the prediction of poor functional outcome with sufficient reliability in an early phase of the disease process. Conversely, the absence of signs of degeneration does not imply that complete recovery is to be expected.
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Electromiografía , Parálisis de los Pliegues Vocales/fisiopatología , Adulto , Femenino , Humanos , Masculino , Pronóstico , Estudios Prospectivos , Parálisis de los Pliegues Vocales/etiologíaRESUMEN
OBJECTIVE: The question whether progressive sensorineural hearing loss during childhood is the fateful course of a main illness has been discussed controversially over 60 years. No medicamentous therapy with satisfactory results has been described in the literature. The goal of this study was to determine whether an infusion therapy, developed for the treatment of sudden hearing loss in the elderly, can induce recovery after progression in sensorineural hearing loss during childhood. METHODS: Out of 20 children suffering from acute progression in sensorineural hearing loss, seven children were treated with an infusion therapy containing prednisolone, pentoxifylline and a plasma expander (group I), and 13 children were not treated (group II). All children were advised not to use hearing aids for 6 weeks. RESULTS: In group I, we observed partial to complete restoration of hearing threshold towards the original hearing threshold given by previous routine controls in 6/7 children. In group II, only three children recovered, with the state of ten children's' hearing loss remaining unchanged. The long-term follow-up, however, showed no distinct difference in either group. CONCLUSION: Infusion therapy can be helpful when treating acutely progressing sensorineural hearing loss during childhood. The benefit for communicative competence has to be discussed. Further studies should be conducted.
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Pérdida Auditiva Sensorineural/tratamiento farmacológico , Pentoxifilina/uso terapéutico , Sustitutos del Plasma/uso terapéutico , Prednisolona/uso terapéutico , Estudios de Casos y Controles , Niño , Preescolar , Progresión de la Enfermedad , Quimioterapia Combinada , Estudios de Seguimiento , Humanos , Pentoxifilina/administración & dosificación , Sustitutos del Plasma/administración & dosificación , Prednisolona/administración & dosificación , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJECTIVES/HYPOTHESIS: Histopathological characteristics of pleomorphic adenomas, especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration, satellite nodules, and pseudopodia in the different subtypes, are described. STUDY DESIGN: Prospective unselected series of 100 consecutive cases from 1997 to 2000. METHODS: Light microscopic examination and semiquantitative analysis of the pleomorphic adenomas. RESULTS: Fifty-one (51%) pleomorphic adenomas were classified as myxoid (stroma-rich) type, 35 (35%) specimens as cellular type, and 14 (14%) as classic subtype. Ninety-seven percent of all tumors showed areas with thin (<20 microm) capsule independent of the tumor subtype. Tumors of myxoid subtype showed the absolute greatest regions of a thin capsule. Especially, tumors of myxoid type (71%) often had a distinct focal absence of encapsulation with tumor merging into normal parotid gland tissue; 11% of the cellular subtype and 43% of the classic subtype presented capsule-free areas. Thirty-three percent of the myxoid pleomorphic adenomas, 23% of the cellular subtype, and 21% of the classic subtype had satellite nodules or pseudopodia. CONCLUSIONS: Almost all pleomorphic adenomas have focally thin capsules. One-fourth of all pleomorphic adenomas contain abnormalities such as satellite nodules or pseudopodia. More than two-thirds of pleomorphic adenomas of the myxoid (stroma-rich) subtype and at least half of all tumors show a focal absence of the capsule. Therefore, enucleation or local dissection of the pleomorphic adenoma is not a sufficient surgical treatment of this special tumor entity. We recommend, depending on the location of the tumor, a lateral or total parotidectomy as the treatment of choice.
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Adenoma Pleomórfico/patología , Neoplasias de la Parótida/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Glándula Parótida/patología , Estudios ProspectivosRESUMEN
Antiphlogistic-rheologic infusion therapy is a widespread and well-established treatment modality for acute idiopathic facial paralysis (AIFP) in many German centers of otorhinolaryngology. However, there is still a lack of convincing data concerning this regimen's functional results and side effects. The medical records of 344 patients who were treated for AIFP between 1987 and 1997 were analyzed retrospectively. In 239 cases there was reliable information on functional outcome. Therapy consisted uniformly of intravenous infusion with prednisolone (250 mg initially, then tapering over 18 days) and simultaneous administration of dextran and pentoxifylline. From 239 patients with non-recurrent palsy having received treatment within 12 days after onset, 92.1% recovered completely without sequelae. In case of incomplete palsy (House-Brackmann grade II-V), normal facial function was restored in 97.7% of cases. Results were significantly better in the group in which therapy had been started within 3 days after onset of palsy. Adverse effects occurred rarely and were transient and mild in most cases. High-dose prednisolone in combination with low-molecular dextran and pentoxifylline for AIFP is a safe treatment modality leading to recovery rates superior to the most optimistic observations of the natural course of Bell's palsy. In the absence of a definitive controlled trial, the present study, although retrospective, is considered valid to show the effectiveness of our protocol. In the light of our data and of other publications, early treatment with corticosteroids in sufficient dosage seems appropriate, while therapeutic nihilism in AIFP does not seem justified.
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Antiinflamatorios/administración & dosificación , Dextranos/administración & dosificación , Parálisis Facial/tratamiento farmacológico , Pentoxifilina/administración & dosificación , Sustitutos del Plasma , Prednisolona/administración & dosificación , Vasodilatadores/administración & dosificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinflamatorios/efectos adversos , Niño , Preescolar , Dextranos/efectos adversos , Esquema de Medicación , Quimioterapia Combinada , Parálisis Facial/etiología , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Pentoxifilina/efectos adversos , Prednisolona/efectos adversos , Recurrencia , Reología/efectos de los fármacos , Resultado del Tratamiento , Vasodilatadores/efectos adversosRESUMEN
BACKGROUND: In many parts of Germany fine-needle aspiration biopsy (FNAB) is still not part of the routine preoperative diagnostic evaluation of salivary gland neoplasms. Most opponents consider the study unnecessary and recommend that all salivary gland neoplasms should be excised. OBJECTIVE: Because of this an evaluated the ability of FNAB to provide an accurate diagnosis of parotid gland neoplasms. PATIENTS AND METHOD: Between January 1992 and October 1995, 336 patients referred for operative therapy of salivary gland neoplasms underwent retrospective analysis of preoperative FNAB compared with the excised tumor histology. RESULTS: Results showed that the FNAB had a sensitivity of 93.1%, a specificity of 99.2%, a positive predictive value of 93.1%, a negative predictive value of 99.2% and an accuracy of 98.6%. Complications were observed in less than 1%. DISCUSSION: Our findings demonstrated that the FNAB is a safe diagnostic tool that has a reliable sensitivity and high specificity for the assessment of salivary gland pathology. Since many malignant salivary gland neoplasms present with a virtual lack of symptoms indicating actual malignancy we believe that there is need for FNAB in routine preoperative diagnostic testing.
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Neoplasias de la Parótida/patología , Adolescente , Adulto , Biopsia con Aguja , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Glándula Parótida/diagnóstico por imagen , Glándula Parótida/patología , Glándula Parótida/cirugía , Neoplasias de la Parótida/diagnóstico por imagen , Neoplasias de la Parótida/cirugía , Estudios Retrospectivos , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
OBJECTIVE: Olfactory dysfunction is a common finding in patients with chronic rhinosinusitis (CRS). The aim of this study was to investigate the relationship between olfaction and nasal flow as determined by active anterior rhinomanometry (AAR). METHODS: Thirty patients with CRS were included in this series. Patients' histories and subjective assessments of olfaction were documented with questionnaires. Smell tests, assessments of olfaction, AAR, and results of rhinoscopy were recorded, including odor identification, discrimination and thresholds measured with the "Sniffin' Sticks"-test. RESULTS: CRS influenced olfactory performances variably in the different tests: 10% of the patients had pathologic rates of odor discrimination, compared with 34% in odor identification and 73% in thresholds. Statistical analyses (using Spearman's test) indicated a significant correlation between nasal airflow and odor identification screening (r29 = 0.56, P < 0.01) and n-butanol-threshold (r29 = 0.44, P < 0.05), respectively. CONCLUSION: Olfactory performance in CRS was correlated to several parameters of nasal airflow measured with AAR. The n-butanol threshold test revealed the most frequent pathological results and may best be used for detecting olfactory disorders. However, because a number of factors may influence olfactory dysfunction in CRS, our findings must be evaluated in a lager series.
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Obstrucción Nasal/fisiopatología , Trastornos del Olfato/fisiopatología , Rinitis/fisiopatología , Sinusitis/fisiopatología , Adolescente , Adulto , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Manometría , Persona de Mediana Edad , Obstrucción Nasal/diagnóstico , Odorantes , Trastornos del Olfato/diagnóstico , Rinitis/diagnóstico , Umbral Sensorial/fisiología , Sinusitis/diagnósticoRESUMEN
Nitric oxide (NO) can play an important role in the regulation of vascular tone and neurotransmission, as well as in non-specific immunoreactions and inflammation in a variety of tissues. Increased quantities of nitric oxide in respired air can be measured during inflammatory processes. However, the exact role and precise sources of NO under physiological and pathophysiological conditions within the airways remain to be defined. Three isoforms of NO-synthases can be distinguished: two constitutive (neuronal and endothelial) Ca(2+)-dependent cNOS and one inducible Ca(2+)-independent iNOS (NOS II). Constitutive NOS (NOS I and III) release a basal amount of NO under physiological conditions. The inducible form once expressed can catalyse the generation of large quantities of NO. Many kinds of cells, such as macrophages, neutrophils, endothelium and smooth muscle cells, are capable of expressing NOS II. Since all isoforms of NO-synthase seem to be present in nasal tissues and the expression of iNOS under inflammatory conditions seems to be responsible for excessive production of NO, the distribution of NOS-isoforms (especially NOS II) in normal and inflammatory nasal tissue, as well as the exact requirements for expression of iNOS remain to be proven. Non-inflamed fresh human nasal mucosa from the middle turbinate was compared immuno-histologically with nasal mucosa having the typical findings of chronic polypoid rhinosinusitis (i.e., polypoid middle turbinates and polyps of the middle nasal duct). In order to gain more information about the mechanisms of acute inflammation, non-inflamed vital turbinates were incubated in vitro with the proinflammatory substances bacterial lipopolysaccharides (LPS) and tumor necrosis-factor (TNF) for 30, 60, 90, 120, 180 and 240 min. Subsequent to exposure to NADPH-diaphorase and immunostaining with specific antibodies to each NOS-isoform, clearly increased or initiated expressions of inducible NOS (iNOS) in blood vessels, glands, macrophages and epithelium of chronically inflamed and LPS-incubated nasal tissue became apparent in comparison to the non-inflamed controls. In contrast, NOS III/NOS I seemed to be not affected. The onset of immunohistochemically recognizable NOS II expression was observed after 90 min incubation with of LPS/TNF-alpha. Polypoid tissue showed a strong increase in submucosal thickness and a high infiltration of iNOS-positive leukocytes (granulocytes and macrophages) compared to the LPS-incubated non-inflamed specimens. These findings implicate NOS II generated nitric oxide as a key agent for causing swelling, secretion and obstruction in patients with acute and chronic polypoid or allergic rhinitis. These findings also suggest that molecular NO has to be considered in the pathophysiology of chronic polypoid rhinosinusitis.