The role of the rhinostomy ostium size on functional success in dacryocystorhinostomy / O papel do tamanho do óstio da rinostomia no sucesso funcional em dacriocistorrinostomia

Abstract Introduction Endonasal and external dacryocystorhinostomy procedures have both been used for the treatment of post-saccular obstruction of the lacrimal system. Functional success of these surgeries depends on several factors. Objective To evaluate the status of the rhinostomy ostium with endonasal and external approaches in dacryocystorhinostomy operations and to determine the effect of ostium size on postoperative functional success. Methods The charts of the patients operated in our hospital between May 2017 and January 2019 were analyzed retrospectively (ethical approval number: 2018-12.04). The patients that were operated in the ophthalmology and otolaryngology departments were included in the study. Endoscopic rhinostomy ostium measurements, punctum lavage findings and complications were recorded at 8 weeks postoperative at the earliest. Results When the 64 patient charts were reviewed (76 operations), the mean ostium width was 1.85 ± 1.11 mm in the endonasal approach group and 3.60 ± 2.24 mm in the external approach group. The mean ostium areas in endonasal and external group were 14.61 ± 16.66 mm2 and 56.05 ± 60.41 mm2, respectively. The ostium was anatomically patent and punctum lavages were negative in 11 patients (6 patients in the endonasal approach group and 5 patients in the external approach group) and these cases were considered as functional failures. The rhinostomy ostium was significantly wider in the external approach group, but this was considered ineffective on functional outcomes. Conclusion Lacrimal duct stenosis can be successfully treated with endonasal and external methods. Tear drainage may be insufficient even in the presence of a patent ostium. Therefore, functional success should also be considered when evaluating the overall success of dacryocystorhinostomy. An anatomically patent ostium is definitely required, while it is believed that ostium size does not affect functional surgical success.

Resumo Introdução Dacriocistorrinostomia endonasal e externa têm sido usados para o tratamento de obstrução pós‐sacular do sistema lacrimal. O sucesso funcional dessas cirurgias depende de vários fatores. Objetivo Avaliar o status do óstio da rinostomia nas abordagens endonasal e externa em dacriocistorrinostomias e a importância do tamanho do óstio no sucesso funcional pós‐operatório. Método Os prontuários de pacientes operados em nosso hospital entre maio de 2017 e janeiro de 2019 foram analisados retrospectivamente (número de aprovação ética: 2018-12,04). Foram incluídos no estudo os pacientes operados nos setores de oftalmologia e otorrinolaringologia. Medidas do óstio da rinostomia endoscópica, achados à irrigação do ponto lacrimal e complicações foram registrados a partir da 8ª semana de pós‐operatório. Resultados Foram avaliados prontuários de 64 pacientes (76 operações); a largura média do óstio era de 1,85 ± 1,11 mm no grupo endonasal e de 3,60 ± 2,24 mm no grupo externa. As áreas médias do óstio no grupo endonasal e externa foram 14,61 ± 16,66 mm2 e 56,05 ± 60,41 mm2, respectivamente. O óstio estava anatomicamente pérvio e as irrigações do ponto lacrimal foram negativas em 11 pacientes (6 pacientes no grupo endonasal e 5 pacientes no grupo externa) e esses casos foram considerados como falhas funcionais. O óstio da rinostomia foi significativamente maior no grupo externo, mas sem relação com a eficácia nos resultados funcionais. Conclusão A estenose do ducto lacrimal pode ser tratada com sucesso com métodos endonasais e externos. A drenagem lacrimal pode ser insuficiente mesmo na presença de óstio pérvio. Portanto, o sucesso funcional também deve ser considerado ao avaliar o sucesso do procedimento. Embora um óstio anatomicamente patente seja necessário, o tamanho do óstio não afeta o sucesso cirúrgico funcional.

Diameter of the orifice of the left coronary artery: angiographic study / Diámetro del ostio de la arteria coronaria izquierda: estudio angiográfico

SUMMARY: The ongoing advances in the technology of coronary artery angiograms have put high demands on the basic knowledge of coronary arteries. This study describes the angiographic morphology of the ostium (orifice) of the left coronary artery among Sudanese with respect to sex, age, length, and BMI. The study design is a cross-sectional retrospective hospital-based conducted from 2014 to 2016. The inclusion criterion of participants is adult males and females presented to the cardiac centers for elective angiograms. The exclusion criteria are age below 18 years, documented congenital heart disease, and previous coronary bypass. Angiograms were done using a digital radiographic system. Data was collected through a predesigned data collection sheet. The data were entered and analyzed using SPSS v27. A test of correlation was done between the different variables. The data were presented in the form of tables. A P-value of <0.05 was considered statistically significant. The total number of participants was 441; males and females represent 42.9 % and 57,1 %, respectively. The mean age of participants was 56.24±8.68 years. The left coronary artery originated from the left aortic sinus. The mean diameter and length of the left coronary artery were 3.8±0.70 mm and 8.1576±4.32 mm, respectively. A significant negative correlation was reported between the diameter of the orifice and both age and length of the left coronary artery. A non-significant difference between males and females in the diameter of the left coronary artery at ostium (P=0.058) and a significant difference in the length (P=0.00). Sudanese have the smallest diameter of the orifice of the left coronary artery among Africans. Sudanese males have a smaller diameter of orifice than females; females have the longest arteries. A wider orifice of the left coronary artery is associated with a short arterial length.

RESUMEN: Los avances en la tecnología de los angiogramas de las arterias coronarias constituyen importantes exigencias al conocimiento básico de las arterias coronarias. Este estudio describe la morfología angiográfica del ostio de la arteria coronaria izquierda (ACI) entre los sudaneses respecto al sexo, la edad, la longitud y el IMC. El estudio es un diseño hospitalario retrospectivo transversal realizado entre 2014 y 2016. El criterio de inclusión de los participantes, hombres y mujeres adultos, fue aquellos que se realizaron angiografías electivas en los centros cardiológicos Los criterios de exclusión fueron: edad menor de 18 años, cardiopatía congénita documentada y bypass coronario previo. Los angiogramas se realizaron utilizando un sistema radiográfico digital. Los datos se obtuvieron a través de una ficha de datos prediseñada. Estos fueron ingresados y analizados con SPSS v27. Se realizó una prueba de correlación entre las diferentes variables. Los datos se presentaron en forma de tablas. Un valor P de <0,05 se consideró estadísticamente significativo. El número total de participantes fue de 441; Hombres y mujeres representanron el 42,9 % y 57,1 %, respectivamente. La edad media de los participantes fue de 56,24±8,68 años. La arteria coronaria izquierda se originaba en el seno aórtico izquierdo. El diámetro medio y la longitud de la arteria coronaria izquierda fueron 3,8±0,70 mm y 8,1576±4,32 mm, respectivamente. Se encontró una correlación negativa significativa entre el diámetro del ostio, la edad y la ACI. Además se encontró una diferencia no significativa entre hombres y mujeres en el diámetro del ostio de la ACI (P=0,058) y una diferencia significativa en la longitud (P=0,00). Los sudaneses tienen el diámetro del ostio de la arteria coronaria izquierda más pequeño entre los africanos. Los hombres sudaneses tienen un diámetro del ostio de la arteria coronaria izquierda más pequeña y las mujeres tienen las arterias más largas. Un ostio más ancho de la arteria coronaria izquierda se asocia con una longitud arterial corta.

Comparison of natural ostiodilatation and endoscopic sinus surgery in the same patient with chronic sinusitis / Comparação entre a dilatação do óstio natural e a cirurgia endoscópica nasossinusal no mesmo paciente com sinusite crônica

Abstract Introduction Chronic rhinosinusitis is a broad clinical syndrome characterized by mucosal inflammation of the nose and paranasal sinuses. In order for the paranasal sinuses to maintain their physiological functions; the ostiomeatal complex drainage pathways must be open. Surgical procedures are an important treatment option in patients who do not respond adequately to medical treatment. Although the methods and instruments used in functional endoscopic sinus surgery have continued to improve in recent years, the scar tissue formed during operation disrupts the drainage of the sinuses and reduces postoperative success. The natural ostiodilatation method, which is performed by balloon sinoplasty method, has become more and more popular in recent years. Objectives To compare the technique of balloon sinoplasty with the classical functional endoscopic sinus surgery method by considering the severity of chronic sinusitis on the same patient. Methods Total of 61 chronic sinusitis patients was included in the study. Paranasal sinus tomography of the patients was taken and according to the Lund-Mackay scoring, chronic sinusitis levels were determined. Cases were divided into two groups: Group 1 (severe chronic sinusitis group) and Group 2 (mild chronic sinusitis). Results There was no statistically significant difference in the results of comparison of sinuses which underwent balloon sinoplasty and classical functional endoscopic sinus surgery in Group 2 after Lund-Mackay scores. However in Group 1, the results of the comparison of postoperative Lund-Mackay scores of the balloon sinoplasty and the classical endoscopic operation were statistically significantly lower than those of the face half operated with the classical functional endoscopic sinus surgery. Conclusion The success of balloon sinoplasty in patients with mild sinusitis is the same as in classic functional endoscopic sinus surgery. However, as the severity of sinusitis increases, the efficacy of balloon sinoplasty decreases.

Resumo Introdução A rinossinusite crônica é uma síndrome clínica ampla, caracterizada por inflamação da mucosa nasal e seios paranasais. Para que os seios paranasais mantenham suas funções fisiológicas, as vias de drenagem do complexo ostiomeatal devem estar abertas. Os procedimentos cirúrgicos são uma importante opção de tratamento em pacientes que não respondem adequadamente ao tratamento clínico. Embora os métodos e instrumentos utilizados na cirurgia endoscópica funcional dos seios paranasais tenham melhorado continuamente, o tecido cicatricial formado durante a cirurgia interrompe a drenagem dos seios nasais e reduz o sucesso pós-operatório. O método natural de dilatação ostial, que é aplicado por meio da técnica de sinuplastia com balão, tem se tornado cada vez mais popular nos últimos anos. Objetivos Comparar a técnica de sinuplastia com balão com o método convencional de cirurgia endoscópica, no mesmo paciente, considerando a gravidade da rinossinusite crônica. Método Foram incluídos no estudo 61 pacientes com rinossinusite crônica. Por meio de tomografia dos seios paranasais e de acordo a escala de Lund-Mackay foram determinados os graus da rinossinusite crônica. Os casos foram divididos em dois grupos: Grupo 1 (grupo com rinossinusite crônica grave) e Grupo 2 (rinossinusite crônica leve). Resultados No Grupo 2 não houve diferença estatisticamente significante, segundo a escala de Lund-Mackay, no resultado da comparação dos seios paranasais nos quais foram realizadas a sinuplastia com balão e por cirurgia endoscópica convencional. No entanto, no Grupo 1, os resultados da comparação dos escores pós-operatórios de Lund-Mackay mostraram-se estatística e significativamente melhores naqueles submetidos à cirurgia endoscópica funcional dos seios paranasais. Conclusão O sucesso da sinuplastia com balão em pacientes com rinossinusite leve é o mesmo da cirurgia endoscópica funcional dos seios da face tradicional. No entanto, à medida que a gravidade da rinossinusite aumenta, a eficácia da sinuplastia com balão diminui.

Importância do complexo osteomeatal no planejamento do levantamento de seio maxilar / Importance of the evaluation of the osteomeatal complex in the planning of maxillary sinus lift

O desvio de septo nasal, concha bolhosa e a obstrução do óstio são alterações do complexo osteomeatal, que podem interferir no volume dos seios maxilares, em sua oxigenação, drenagem adequada de fluidos e nos resultados de cirurgias nessa região. A adoção de um protocolo de avaliação do complexo osteomeatal envolvendo uma equipe multidisciplinar no planejamento de cirurgias de levantamento de seio maxilar pode proporcionar a diminuição do surgimento de complicações pós-operatórias relacionadas à drenagem e ventilação, prejudicadas pelo desvio de septo nasal, concha bolhosa e obstrução do óstio.

Nasal septum deviation, concha bullosa and ostium obstruction are alterations of the osteomeatal complex that may interfere with the volume of the maxillary sinuses, their oxygenation, adequate drainage of fluids and the results of surgeries in this region. The adoption of a protocol for evaluation of the osteomeatal complex involving a multidisciplinary team in the planning of surgeries of maxillary sinus can provide a reduction in the appearance of postoperative complications related to drainage and ventilation impaired by nasal septum deviation, concha bullosa and obstruction of the ostium.

Correlations between anatomic variations of maxillary sinus ostium and postoperative complication after sinus lifting

OBJECTIVES: The maxillary sinus mucosa is reported to recover to preoperative sterility after sinus floor elevation. However, when drainage of maxillary sinus is impaired, recovery can be delayed and maxillary sinusitis can occur. Therefore, in this study, we investigated the correlations between anatomic variants that can interrupt the ostium of the maxillary sinus and incidence of complication after sinus lifting. MATERIALS AND METHODS: The subjects are 81 patients who underwent sinus lifting in Wonkwang University Dental Hospital (Iksan, Korea). Computed tomography (CT) images of the subjects were reviewed for presence of nasal septum deviation, anatomic variants of the middle turbinate, and Haller cells. Correlations between anatomic variations and occurrence of maxillary sinusitis were statistically analyzed. RESULTS: Patients with anatomic variants of ostio-meatal units, such as deviated nasal septum, concha bullosa or paradoxical curvature of the middle turbinate, or Haller cells, showed a higher rate of complication. However, only presence of Haller cell showed statistically significant. CONCLUSION: Before sinus lifting, CT images are recommended to detect anatomic variants of the ostio-meatal complex. If disadvantageous anatomic variants are detected, the use of nasal decongestants should be considered to reduce the risk of postoperative sinusitis.

Caracterização morfométrica do pênis e prepúcio de touros das raças Nelore e Gir / Morphometric characterization of the penis and prepuce of Nelore and Gir bulls

O objetivo deste trabalho foi caracterizar alguns aspectos morfométricos do pênis e prepúcio de touros das raças Nelore e Gir, estabelecendo as correlações destes parâmetros com outras medidas corporais. O protocolo experimental foi dividido em duas etapas, sendo que na primeira foram selecionados 40 touros, 20 da raça Nelore e 20 da raça Gir, com idade de 30 a 38 meses e peso entre 382 e 468 Kg. Após o abate dos animais em frigorífico, foram coletadas peças de pênis para dissecação e morfometria. Na segunda etapa, foram selecionados 43 touros, 23 da raça Nelore e 20 da raça Gir, com idade de 60 a 96 meses e peso entre 890 a 1120 Kg, provenientes de centrais de coleta de sêmen, para mensuração do peso e comprimento corporal, comprimento da garupa, perímetro torácico, altura anterior e posterior, menor perímetro do metacarpo esquerdo e do metatarso esquerdo, comprimento do prepúcio, menor distância do óstio prepucial à parede do abdome e perímetro do óstio prepucial. As medidas obtidas foram submetidas a teste de correlação linear. O comprimento médio do pênis e prepúcio de touros da raça Nelore foi de 71,96 cm e 52,4 cm, respectivamente e nos touros da raça Gir de 75,73 cm e 57 cm, respectivamente. Dentre as correlações efetuadas, destacam-se duas positivas; uma baixa entre o comprimento corporal e comprimento prepucial (r = 0,31, p < 0,05) e outra média entre a massa corporal e o comprimento prepucial (r = 0,66, p < 0,05). Os resultados deste estudo poderão contribuir para se estabelecer o padrão destas medidas nas raças Nelore e Gir, além de indicar as correlações com outras medidas corporais que podem ser empregadas para proceder a seleção genética de touros para a reprodução.

The aim of this study was to characterize some morphometric aspects of the penis and prepuce of Nelore and Gir bulls establishing the correlations between these parameters and other body measures. The experimental protocol was divided into two stages, being that in the first stage it was selected 40 animals, 20 Nelore and 20 Gir bulls, aged between 30 to 38 months and weighing between 382 and 486 kg. After the killing of the animals in the slaughterhouse, it was collected pieces of penis for penile dissection and morphometry. In the second stage, were selected 23 Nelore and 20 Gir bulls aged between 60 to 96 months and weighing between 890 and 1120 kg. The animals were obtained from semen collection centrals and were submitted to measurement of body mass and length, rump length, thoracic perimeter, anterior and posterior height, the lower perimeter of the left metacarpal and metatarsal, length of the prepuce, the shortest distance from preputial ostium to abdominal wall and the preputial ostium perimeter. The measures obtained were subjected to linear correlation test. The average length of the penis and prepuce of Nelore bulls were 71.96 cm and 52.4 cm respectively and in the Gir bulls were 75.73 cm and 57 cm respectively. Two positive correlations stand out among the analysis performed, the low correlation between body and preputial length (r = 0,31, p < 0,05) and mean correlation between body mass and preputial length (r = 0,66, p < 0,05). The results of this study could contribute to establish the pattern of these measures in the Nelore and Gir races and indicate the correlations with other body measures that can be considered to perform the genetic selection of bulls for breeding.

Patterns of sudanophilic lesions at ostia of descending thoracic and abdominal aorta in cholesterol-fed adult rabbits / Patrones de lesiones sudanofílicas en el ostio de las partes torácica y abdominal de la aorta en conejos adultos alimentados con colesterol

Sudan-positive atherosclerotic lesions preferentially occur at downstream and lateral margins of arterial branch ostia in human neonates and weanling rabbits but tend to develop at lateral and upstream margins in old subjects. We investigated (i) the pattern of sudanophilic lesions at aortic ostia of cholesterol-fed adult rabbits and (ii) determined any differences in lesion distribution between descending thoracic and abdominal aorta. Ten adult males, New Zealand white rabbits were fed 2 percent high cholesterol diet. After six weeks, aortas were excised, opened longitudinally and stained with Sudan-IV for gross examination of atherosclerotic lesions. A total of 156 descending thoracic and 90 abdominal ostia were examined. Mean lesion frequencies upstream, downstream and at lateral margins of the affected ostia were calculated and compared. Sudanophilic lesions were detected around 32 percent ostia of descending thoracic aorta and 25 percent those of abdominal aorta. At ostia of descending thoracic aorta, lesion frequencies were significantly higher (P<0.001) downstream (95 percent) and at lateral margins (92 percent) than upstream (2 percent). In abdominal aorta, lateral (100 percent) and upstream (43 percent) margins were significantly (P<0.05) more affected while minimal lesion frequencies were seen at downstream branch points (9 percent). Comparison between descending thoracic and abdominal aorta showed an insignificant difference of lesion frequencies at lateral margins (P>0.05) but a highly significant difference at upstream versus downstream of ostia (P<0.001). We concluded that in cholesterol-fed adult rabbits, juvenile pattern of downstream lipid deposition persists at ostia of descending thoracic aorta while a switch towards the upstream pattern of old subjects occurs at ostia of abdominal aorta.

Las lesiones ateroscleróticas Sudán-positivas se producen preferentemente en los márgenes posteriores y laterales del ostio de las ramas arteriales en neonatos humanos y en conejos destetados, pero tienden a desarrollarse en los márgenes laterales y superiores en sujetos de edad avanzada. Investigamos el patrón de lesiones sudanofílicas en el ostio aórtico de conejos adultos alimentados con colesterol y determinamos las diferencias en la distribución de lesiones entre la aorta torácica descendente y abdominal. Diez conejos machos blancos adultos New Zealand fueron alimentados con una dieta alta en colesterol al 2 por ciento. Después de seis semanas, fueron extraídas las aortas, se disecaron longitudinalmente y se tiñeron con Sudan-IV para el examen macroscópico y se observaron las lesiones ateroscleróticas. Fueron examinados 156 ostios de aortas torácicas descendentes y 90 de aortas abdominales. Fueron calculadas y comparadas las frecuencias medias de lesiones superiores, inferiores y de los márgenes laterales de los ostios afectados. Las lesiones sudanofílicas se detectaron en alrededor del 32 por ciento de ostios de la aorta torácica descendente y en el 25 por ciento de las aortas abdominales. En el ostio de la aorta torácica descendente, las frecuencias de lesiones fueron significativamente mayores (p <0,001) por superior (95 por ciento) y en los márgenes laterales (92 por ciento) que por inferior (2 por ciento). En la aorta abdominal, los márgenes laterales (100 por ciento) y superiores (43 por ciento) fueron significativamente más afectados (p <0,05), mientras que las frecuencias mínimas de lesiones se observaron en los puntos de la rama descendente (9 por ciento). La comparación entre la aorta torácica descendente y abdominal mostró una diferencia no significativa de las frecuencias de lesiones en los márgenes laterales (p> 0,05), pero muy significativa al comparar el margen superior con el inferior (p <0,001). Llegamos a la conclusión que en los conej...

Medialization and stabilization of the middle turbinate using a nasal septal flap in endoscopic sinus surgery

Objectives: To propose a simple technique to preserve, medialize and stabilize the middle turbinate through a planned medial synechiae formation using a nasal septal flap Methods: a. Study Design: Case series, surgical innovation b. Setting: Tertiary hospital (Kumamoto University Hospital, Japan) c. Participants, Patients or Population: Six patients suffering from chronic sinusitis unresponsive to medication. The indication for doing this technique was unstable turbinates after removal of diseased mucosa. Results: Twelve weeks after surgery, the patients reported significant resolution of symptoms (headache, nasal congestion, rhinorrhea, post-nasal drip and loss of smell). CTand endoscopic findings likewise revealed clear ostio-meatal complex, drained sinuses, and complete removal of polypoid mucosa. No major side effects were noted. Conclusions: This technique is especially encouraged when surgeons encounter an unstable middle turbinate after removing massive pathologic mucosal lesions. This is a preliminary report and further investigations are being carried out to validate the technique. (Author)