Comparison of Jack dilator-kyphoplasty and balloon-kyphoplasty in postoperative vertebral height loss and adjacent intervertebral disc degeneration / 中华创伤骨科杂志

Objective:To compare Jack dilator-kyphoplasty (DKP) and balloon-kyphoplasty (BKP) for osteoporotic vertebral compression fracture (OVCF) in postoperative vertebral height loss and adjacent intervertebral disc degeneration.Methods:A total of 94 OVCF patients were treated and fully followed up at Department of Orthopaedic Surgery, The First Hospital Affiliated to Nanjing Medical University from May 2007 to October 2016. Of them, 30 were subjected to DKP and 64 to BKP. In DKP group, there were 18 males and 12 females, with an age of (72.4±9.2) years, a bone density of (-3.99±0.88) SD and a disease course of (0.7±0.4) months; in BKP group, there were 28 males and 36 females, with an age of (71.6±14.3) years, a bone density of (-4.08±0.63) SD and a disease course of (0.6±0.3) months. The 2 groups were compared in terms of change in the height of injured vertebrae, disc height index percentage (DHIP) and Pfirrmann grading of adjacent disc degeneration at preoperation, 2 days and 36 months after operation.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data ( P>0.05). The anterior and middle heights of injured vertebrae and DHIP at postoperative 36 months were significantly lower than those at postoperative 2 days in both groups ( P<0.05). There was no significant difference between the 2 groups in DHIP at 36 months after operation (79.86%±4.48% versus 80.24%±6.85%) ( t=0.277, P=0.782). By the Pfirrmann grading, 36 and 84 patients had intervertebral disc degeneration in DKP and BKP groups respectively. There was no significant difference in the incidence of intervertebral disc degeneration between the 2 groups (60.0% versus 65.6%) (χ 2=0.560, P=0.454). Conclusions:In the OVCF treatment, DKP and BKP may potentially cause height loss of the injured vertebrae and degeneration of adjacent intervertebral disc, but no difference was found in disc degeneration between the 2 modes.

recurrent hemorrhoids-efficacy, utility and initial experience with the use of stapled hemorrhoidopexy in recurrent hemorrhoids

Overview: Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods: The present prospective case series enrolled a total of 87 patients (54male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. Amodification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results: Stapled hemorrhoidectomy (SD)was performedin13patientswho had historyof previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion: Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD. (AU)

Effect of breast external tissue expander assisted autologous fat transplantation in augmentation mammoplasty / 中华医学美学美容杂志

Objective:To explore the method and experience of augmentation mammoplasty with autologous fat transplantation assisted by external expander.Methods:From January 2013 to December 2020, 352 female patients (698 breasts, 346 bilateral and 6 unilateral), aged from 18 to 55 years, with an average age of 41.5 years, were admitted to the Department of Cosmetic Surgery, Beijing Jingmei Medical Cosmetology Clinic. From 1-28 days before surgery, autologous fat transplantation was performed after wearing the dilator, and postoperative wearing of the dilator lasted from 1 to 24 months, with an average of 3.5 months.Results:The volume of fat transplantation per breast ranged from 150 ml to 460 ml, with an average of 320 ml. No obvious postoperative complications such as fat liquefaction, infection, intramammary induration and fat embolism were observed, and the postoperative appearance was lasting. The postoperative follow-up was conducted from 6 months to 7 years, and patient postoperative satisfaction rate reached 84.9% and doctors＇ satisfaction after surgery reached 82.1%.Conclusions:Augmentation mammoplasty with autologous fat transplantation assisted by external expander can effectively improve the appearance of breast morphology and contour defects and increase the survival rate of fat transplantation, which is worthy of clinical application.

Study and Analysis on the Test of Representative Products for Percutaneous Renal Puncture Device / 中国医疗器械杂志

Percutaneous renal puncture device has very important clinical value. Qualified percutaneous renal puncture device is one of the important ways to evaluate its safety and efficacy, and it is also an important prerequisite for the device to be marketed in China. When manufactuers test the product, the selection of representative products is suggested from the aspects of performance parameter, structure, material and production process.

Development of an environment-friendly and sterile four- blade vaginal dilator for LEEP surgery / 中国医学装备

Objective: To develop an environment-friendly and sterile four- blade vaginal dilator so as to resolve the problem of polluting environment that petroleum-based plastics released hydrogen chloride, dioxin and other poisonous and cancerogenic substance. Methods: The lower blade of the environment-friendly and sterile four-blade vaginal dilator was used as fixed blade, and upper blade, left blade and right blade were extensible and closable. And in the left and right blades, there were built-in smog exhaust tubes. And based on the previous invention of the twin-blades vaginal dilator, the device has been redesigned and developed by adding the left blades, right blades, locating sleeve and other related parts. Results: When the device expanded, both of left and right blades could extend out, and when it closed, both of them could be folded into the upper and lower blades. Therefore, it was safety and effective. Besides, the built-in smoking tubes of left and right blades could quickly exhaust harmful smog by the closest distance, and the plastics used in this device was not only environmentally friendly, but also it was insulation and cost-effective. Conclusion: The environment-friendly and sterile four-blades vaginal dilator used in LEEP surgery resolved two problems included the constructs of imported four-blades vaginal dilator were complex and the left and right blades couldn't extend out. And it effectively enhance the expand distance between left and right blades, and it enlarges operation field and surgery space. Besides, the use of the environmentally friendly plastics avoids the environmental pollution caused by the release of hydrogen chloride, dioxins and other toxic and carcinogenic substances when built-out smoking tubes and petroleum base plastics were incinerated. Therefore, it enhances the surgical quality.

Treatment of paediatric stone disease in middle and lower ureter with fascia dilator and ureteroscopic holmium laser / 中国内镜杂志

Objective To evaluate the methods for treatment of paediatric stone disease in middle and lower ureter with fascia dilator and ureteroscopic holmium laser. Methods For 35 child patients with middle and lower ureteral calculi, the dilation of orifice was taken by 6.0 ～ 8.0 F fascia dilator, then ureteroscopic holmium laser lithotripsy followed. Results Among the 35 cases, 33 cases were the successful gravel, with a total rate of 94.3％ gravel. In other two cases, the broken stones were rushed into the renal pelvis and ESWL was successfully carried. Conclusion Fascia dilator and ureteroscopic holmium laser in paediatric middle and lower ureteral calculi can improve the successful rate of operation and reduce the operation risks. It is safe and effective.

Early efficacy of Jack vertebral dilator kyphoplasty bone grafting combined with minimally invasive fixation for thoracolumbar fractures / 中华创伤杂志

Objective To investigate the short-term clinical efficacy of Jack vertebral dilator kyphoplasty bone grafting combined with minimally invasive fixation in the treatment of thoracolumbar fracture.Methods A retrospective case series analysis was made on 34 patients with thoracolumbar fracture treated by minimally invasive transpedicular bone grafting and fixation in the injury vertebrae with Jack vertebral dilator from December 2014 to December 2015.There were 20 males and 14 females,and their age was 25-27 years (mean,46.7 years).According to the AO classification,there were 16 cases of type A1 and 18 type A3.The injured levels were at T11 in one case,at T12 in 6,at L1 in 15,at L2 in 9 and at L3 in 3.The operation time,blood loss,fluoroscopy frequency,incision length,and postoperative hospital stay duration were recorded.The visual analogue scale (VAS),Oswestry disability index (ODI),height ratio of vertebrae,Cobb angle,and complications were evaluated at follow-up.Results The operation time was (91.2 ±9.8) minutes,blood loss was (42.4 ±4.3) ml,incision length was (7.2 ± 0.4) cm,intraoperative fluoroscopy frequency were five,postoperative hospital stay was (3.9 ± 0.5) days,and follow-up time was (13.8 ± 1.7) months.All the patients showed complete healing in the injury vertebra.The VAS was (6.4 ± 0.9) points preoperatively,(4.1 ± 0.8) points,(1.2 ± 0.4) points,and (1.2 ± 0.5) points at 7 days,3 months and 12 months postoperatively.The ODI was (39.2 ± 2.3) points preoperatively,(24.5 ± 1.9) points,(13.0 ± 3.0) points,and (12.3 ± 2.0) points at 7 days,3 months and 12 months postoperatively.At postoperative 7 days,the VAS and ODI were significantly decreased compared with those preoperatively (P ＜ 0.05) and further declined at postoperative 3 months (P ＜ 0.05),while there was no significant difference between 3 months and 12 months postoperatively (P ＞ 0.05).The height ratio of vertebrae was 47.8 ± 12.2 preoperatively,83.6 ±4.9,82.5 ±4.8,and 81.7 ±4.7 at 7 days,3 months and 12 months postoperatively.The Cobb angle was respective (22.4 ± 4.7) °preoperatively,(3.6 ± 2.4) °,(4.6 ± 2.6) °,and (5.0 ± 2.8) ° at 7 days,3 months and 12 months postoperatively.At postoperative 7 days,the height ratio of vertebrae was increased and Cobb angle was decreased significantly compared to those preoperatively (P ＜ 0.05),while there was no significant difference in the indicators at 3 days,3 months and 12 months postoperatively (P ＞ 0.05).No looseness or breakage of internal fixation was found at follow-up and all patients had fracture union at the last follow-up.Conclusion Jack vertebral dilator kyphoplasty bone grafting combined with minimally invasive fixation is safe and effective for treatment of thoracolumbar fractures,as the procedure can quickly relieve the pain,improve the function disability,effectively maintain the height of the vertebral body and restore the sagittal balance of spine.

Efeitos do dilatador nasal Qiar® na obstrução nasal, ronco, apneia obstrutiva do sono, exercícios físicos e na respiração pelo nariz / Effects of nasal dilator Qiar® on nasal obstruction, snoring,obstructive sleep apnea, physical exercise, and nose breathing

Introdução: O objetivo deste estudo é avaliar o uso do Dilatador Nasal Qiar®– Abridor Nasal e Levantador da Ponta Nasal, em pacientes com obstrução nasal e seus efeitos no ronco, apneia obstrutiva do sono, exercício físico, congestão nasal e respiração nasal. Métodos: Participaram do estudos 30 pacientes que responderam ao questionário da escala de sonolência Epworth, Índice de Qualidade de Sono de Pittsburgh, realizaram exame otorrinolaringológico completo, Rinometria Acústica e Polissonografia. Resultados: Polissonografias demonstraram diferenças significativas entre noite controle e noite de tratamento com Qiar®na eficiência, arquitetura e fragmentação do sono, tempo de ronco e Índice de apneias-hipopneias; Qiar® teve bom impacto no IAH, reduziu 50% do número de eventos respiratórios e em 64,1% o tempo de ronco. Testes de aptidão física demonstraram melhora significativa no tempo e VO2 máximo no grupo Qiar® (31,8 ml/kg/min), comparado ao controle (25,8 ml/kg/min). Houve significativo bem-estar usando Qiar®, 28 pacientes (93,3%) relataram ser melhor ou muito melhor sua respiração e desempenho no teste físico. Todos os resultados foram correlacionados com Rinometria, PSG e Teste de Aptidão Física. Conclusões: Este estudo demonstrou que Qiar® é eficaz na redução da obstrução nasal, roncos e apneia obstrutiva do sono, melhora da respiração durante exercícios físicos, diminuição da congestão nasal, facilita respiração pelo nariz, melhora arquitetura e qualidade do sono. Seu efeito é imediato, sem efeitos colaterais, com ação mecânica, sem medicamentos, pode ser recomendado como alternativas para descongestionantes e corticosteroides nasais tópicos e também para pacientes que não querem ou não podem fazer outros tipos de tratamentos.

Introduction: The aim of this study is to evaluate the use of Nasal Dilator Qiar®, a nasal opener and nasal tip lifter, in patients with nasal obstruction and its effect on snoring, obstructive sleep apnea, exercise, nasal congestion and nasal breathing. Methods:The study included 30 patients who answered the Epworth Sleepiness Scale and the Pittsburgh sleep quality index questionnaires, and underwent complete ENT examination, acoustic rhinometry and polysomnography (PSG). Results: PSG showed significant differences between control night and night with Qiar® treatment in the efficiency, architecture and fragmentation of sleep, time snoring and apnea-hypopnea index (AIH); Qiar® had good impact on the AHI, and it reduced the number of respiratory events by 50% and time snoring by 64.1%. Physical fitness tests demonstrated significant improvement in time and peak VO2 in the Qiar® group (31.8 ml/kg/min) as compared to the control group (25.8 ml/kg/min). There was significant well-being using Qiar®, as 28 patients (93.3%) reported better or much better breathing and physical performance. All results were correlated with Rhinometry, PSG and Physical Fitness Test. Conclusions: This study demonstrated that Qiar® is effective in reducing nasal obstruction, snoring and obstructive sleep apnea, improves breathing during exercise, reduces nasal congestion, eases breathing through the nose and improves the architecture and quality of sleep. Its effect is immediate, without side effects, with mechanical action, without medication, and it can be recommended as an alternative to decongestants and topical nasal corticosteroids and also for patients who do not want or cannot use other types of treatments.

Analysis of the effect of expanded deltopectoral skin flaps in repairing scar contracture deformity of faciocervical for 24 cases / 重庆医学

Objective To discuss the effect of expanded deltopectoral skin flaps in repairing scar contracture deformity of facio-cervical .Methods Twenty-four patients with scar contracture deformity of faciocervical were included into the study .We expanded the deltopectoral skin flap with dilator .8-10 weeks later ,the deltopectoral skin flap were transferred after resection of faciocervical scar .3-4 weeks later ,the pedicles were cut off ,and then the remaining wound were repaired .Results They had not exudation .Ex-pander exposure ,local hematoma and local infection respectively were 1 ,3 ,4 cases ,all did not affect operation effect by symptomatic treatment ,and obtain good postoperative effect .Deltopectoral flap was for 27 cases ,blood supply obstruction low temperature and skin flap necrosis respectively were 4 ,2 ,1 cases ,all get good healing after corresponding .Followed up for 0 .5 year ,all flaps were survived well ,no ectropion or mental cervical adhesion ,its color and texture were similar with surrounding normal skin appearance , so they were got high satisfaction .Conclusion Application of expanded deltopectoral skin flaps to repair scar contracture deformity of faciocervical can achieve good effect and may be an ideal method to repair ,which is worthy of clinical application .

Excessive expansion of scalp with multiple dilators to repair cicatricial alopecia in a large area / 中华医学美学美容杂志

Objective To investigate the application of multiple dilators for excessive expansion of scalp with hair covering and integrated use of expanded flap to repair cicatricial alopecia in a large area.Methods stage Ⅰ surgery was performed as follows:multiple dilators were chosed and embedded below the galea aponeurotica of the scalp with hair covering according to the bald hair shape,size of the alopecia area.Excessive expansion was conducted for 3 to 6 months to get the extra hair scalp.Stage Ⅱ surgery was as follows:Dilators were removed and scar areas were resected,followed by combined use of sliding advancement flap,rotation flap and translocation flap to repair scalp alopecia.Resluts The postoperative effect of all patients was ideal with satisfied appearance.Conclusions Multiple dilator excessive expansion may obtain a large number of additional expansion scalp,combined by reasonable use of skin flap transfer technology,which can be used to repair the large scarring alopecia and get a good clinical effect.

Antegrade insertion of guide wire through suprapubic fistula facilitates retrograde dilation for treatment of early stricture following urethroplasty / 第二军医大学学报

Objective To discuss the feasibility and safety of a novel urethral dilation procedure using antegrade insertion of guide wire through suprapubic fistula (retrograde insertion failed) to facilitate retrograde dilation for treating early stricture following urethroplasty. Methods Thirteen patients, who failed to receive retrograde insertion, developed early stricture following urethroplasty. The guide wire was inserted through a pre-made suprapubic fistula to pass the stricture with the help of flexible cystoscope. Then the guide wire was used to guide polytef catheter to perform retrograde dilation. Results The procedures were successfully done in all the 13 patients. The mean operation time was (10. 7 ± 3. 18) min (8-17 min), and there were no serious complications. Conclusion The present dilation procedure is an effective and safe method for management of early stricture recurrence following urethroplasty.

The use of nasal dilator strips as a placebo for trials evaluating continuous positive airway pressure

OBJECTIVES: The aim of the current study was to compare the objective and subjective effects of continuous positive airway pressure to the use of nasal dilator strips in patients with acromegaly and moderate to severe obstructive sleep apnea. METHODS: We studied 12 patients with acromegaly and moderate to severe obstructive sleep apnea (male/ females = 8/4, age = 52±8 ys, body mass index = 33.5±4.6 Kg/m², apnea-hypopnea index = 38±14 events/h) who had been included in a randomized, crossover study to receive three months of treatment with continuous positive airway pressure and nasal dilator strips. All patients were evaluated at study entry and at the end of each treatment by polysomnography, and Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and treatment satisfaction questionnaires. ClinicalTrials.gov: NCT01265121 RESULTS: The apnea-hypopnea index values decreased significantly with continuous positive airway pressure treatment but did not change with the use of nasal dilator strips. All of the subjective symptoms improved with both treatments, but these improvements were significantly greater with continuous positive airway pressure than with the nasal dilator strips CONCLUSION: The use of nasal dilator strips had a much smaller effect on the severity of obstructive sleep apnea in patients with acromegaly and moderate to severe obstructive sleep apnea in comparison to the use of continuous positive airway pressure. Moreover, the improvement in several subjective parameters without any significant objective improvement in obstructive sleep apnea resulting from the use of nasal dilator strips is compatible with a placebo effect.

Correction of Prominent Alar Lobule by Resecting Dilator Naris Muscles: A Pilot Study

PURPOSE: The authors have conducted a series of anatomic studies on the factors affecting shape of a lower vault in Asian noses. The results of the studies showed that prominence of alar lobule is mainly affected by the volumes of the dilator naris anterior and posterior muscles and the insertions of the dilator naris posterior muscles. However, information on its clinical availability is yet insufficient. The present study was undertaken for clinical purpose to find out the effect of dilator naris muscle resection on the correction of prominent alar lobule. METHODS: Six patients who were treated by dilator naris muscle resection with a long-term follow-up of more than 1 year were involved in this study. Rhinoplasties were performed via endonasal approaches with resecting dilator naris anterior and posterior muscles by sharp scissor. The effect of the dilator naris muscle resection on alar prominence was investigated by measuring ratio of the short axis to the long axis of a nostril(SA/LA) pre-and postoperatively. The visual analog scale(VAS) was also used to evaluate satisfaction of patients. An average follow-up time was 15.6+/-3.7 months. RESULTS: Having lost the dilating and lateral pulling effects of the dilator naris muscles, the alar lobule shifted medially and alar lobule shapes improved. SA/LA significantly improved(preoperatively 0.71+/-0.11 and postoperatively 0.58+/-0.08; p<0.05). The VAS score was also increased postoperatively(preoperatively 3.2+/-1.8 and postoperatively 8.7+/-1.2; p<0.05). A mild degree of hyperpigmented scar was noted in one alar lobule. Otherwise, there was no case of postoperative complication. CONCLUSION: Our results suggest that prominent alar lobule could be modified by resecting the attachment of the dilator naris muscles. This maneuver removes the function of dilator naris muscles, then may produce a more aesthetically acceptable alar lobule shape.

Application of stress and complaisance distention of bile ducts to construct wide caliber local biliary tract in dogs / 中华肝胆外科杂志

Objective To study the feasibility and morphological characteristics of wide caliber of local biliary tract constructed by increasing pressure of local bile duct in a short period of time.Methods Twelve mongrel dogs were randomized into 2 groups.In group A,only inlaid bile duct dilator(IBDD)was placed for biliary drainage in common bile duct.In group B,IBDD was placed in tommort bile duct for biliary drainage and dilated it through affusing 0.1 ml,0.1 5 ml,0.2 ml and 0.25 ml water on postoperative day 1,8,15 and 22,respectively.The expandable ballbladders were kept on being dilated with increasing pressure for a month.Total bilirubin(TB),alanine aminotransferase (ALT),aspartate aminotransferase;aspartate transaminase(AST)of serum,bile duct diameter (BDD),histologic changes of biliary duct wall and hepatic tissue,and postoperative biliary tract contrast were determined before and after operation in both groups.Results There was no significant difference in TB,ALT,AST and histologic changes of hepatic tissue in bilary predilation and postdilation of each group and between group A and group B.There was great difference in BDD in bilary predilation and postdilation of each group and between group A and group B.In group B,the biliary wall was thickened and the lumina of bile duct widened,favorable tenacity of broaden biliary tract was shown.The specific staining of the broadened biliary wall showed that collagen and elastic fibers compacted fine and close and there was no breakage.Conclusion Dilated local bile duct constructed by increasing internal pressure of local bile duct has thick wall,wide caliber and its collagen and elastic fibers compact fine and close.This provides condition to supply early-stage cholangio-jejunostomotic reconstruction of bile duct iniury and create wide stoma for cholangio-jejunostomy in dogs.

Biliary passage dilator assisted percutaneous endoscopic gastostomy in natural orifice translumenal endoscopic surgery / 中华消化内镜杂志

Objective To explore the feasibility and safety of the biliary passage dilator assisted percutaneous endoscopic gastostomy(PEG)in natural orifice translumenal endoscopic surgery(NOTES).Methods Eleven hybrid dogs were recruited to the study.One dog was used for pilot study of biliary passage dilator assisted PEG.The rest ten were divied into 2 groups randomly(5 per group), receiving conventional PEG and biliary passage dilator assisted PEG, respectively.The efficacy and safety of these 2 methods in NOTES were compared.Two weeks later, routine gastroscopy was performed to detect the healing of luminal incision and all animals were sacrificed to explore the possible complications in the abdominal cavity.Results With the assistance of the biliary passage dilator, successful transgastric access to the peritoneal cavity was achieved in the pilot study.Biliary passage dilator assisted PEG was completed in all the 5 dogs of the experimetal group, while tradional PEG succeded in only 4.The average transgastric puncture time in the biliary passage dilator assisted PEG(7.0 ± 1.7 min)was significantly shorter than that of conventional PEG (11.0 ± 3.2 min, P ＜ 0.05).Nine dogs survived for 2 weeks postoperatively without loss of weight or peritonitis.Endoscopy showed transgastric puncture healed well.Autopsy revealed no gross adhering zone,bleeding, injury of adjacent organs or abcasses.Conclusion Compared with the conventional PEG, the biliary passage dilator assisted PEG shows the advantages of reduced difficulty and shoter time of puncture without any apparent complications.There is a good prospect of its application in NOTES.

Endoscopic Removal of a Bile-Duct Stone Using Sphincterotomy and a Large-Balloon Dilator in a Patient with Situs Inversus Totalis

A 45-year-old female with known situs inversus totalis presented with colicky pain in the left upper abdominal quadrant. The laboratory parameters showed elevated neutrophils and a bilirubin level of 2 mg/dL. CT confirmed situs inversus totalis and dilatation of the intra- and extrahepatic ducts with a 10-mm common bile duct (CBD) stone and a 10-mm gallstone. She underwent papillary dilatation using a radial expansion balloon after sphincterotomy, after which the CBD stone was removed with a basket and balloon. There were no complications, such as bleeding, pancreatitis, or perforation. It might be reasonable to attempt a "partial" biliary endoscopic sphincterotomy followed by a large-balloon dilator in patients with concomitant distal bile duct, papillary stenosis, or altered anatomy (e.g., periampullary diverticulum, Billroth II anatomy). However, when performing an "adequate" biliary endoscopic sphincterotomy this is technically difficult, or in some cases even impossible, and is associated with a higher risk of complications. This paper further expands on the application of these techniques and shows that a papillary balloon dilatation after endoscopic sphincterotomy is a safe, easy, and effective technique for removing bile-duct stones in a patient with situs inversus totalis.

Effects of Dimethyl Sulfoxide (DMSO) on the Contraction of the Rat Iris Muscle

PURPOSE: To evaluate the effects of DMSO on the iris muscle contractility and to compare DMSO with other detergents(ethanol and triton-x 100). METHODS: After anesthesizing rats with an intraperitoneal injection of pentobarbital sodium, each animal was fixed under microscope. The pupil response to the drugs was examined by CCD camera and the video edge motion detector was used for measurement of alteration of the pupil size. The pupil response to the drugs was recorded by MacLab chart(version 3.6/s). RESULTS: Miosis induced by DMSO was initiated after 5 minutes, peaked at around 30 minutes and maintained until 3 hours after instillation. Miotic effect of DMSO was in a dose dependent manner ranging 0.01%-10% and was not reversed after washout. All detergents used in the present experiment induced miosis, however, DMSO elicited the strongest miotic response. After pretreatment with atropine, DMSO-induced miotic response was not affected, showing similar changes with control group. CONCLUSIONS: Taken together, it is concluded that DMSO induces miosis by inducing relaxation of iris dilator muscle.

Endoscopic balloon dilatation for patients with achalasia / 中华消化内镜杂志

Objective To evaluate the efficacy and safety of endoscopic balloon dilatation for patients with achalasia. Methods Patients with achalasia, were treated by single or double esophageal balloon dilatation under endoscopy,f ollowed up survey by gastroduodenal endoscopy and esophageal barium radiography as well as their symptoms were investigated periodically. Results The dysphagia symptoms remitted in all of the 43 patients,and mucosal lacerations,abrasions a nd oozing of blood, were found in this process but without complication of perf oration,haematemesis and melena.The following up ranged from 3 months to over 4. 8 yrs,and average was 2.6 yrs.The rate of remission of dysphagia symptoms 90.7 ％ (39/43) at six months,85.3％ (29/34) at 1 yr,82.6％ (19/23) at 2 yrs and 82.4 ％ (14/17) at 3 yrs,and the rate of recurrence of symptoms was 9.3％ (4/43)、 1 4.7％ (5/34)、 17.4％ (4/23)、 17.6％ (3/17),respectively.In addition,there were 37.2％ (16 cases)of patients with acid－ reflux symptoms,30.2％ (13 cases)heart burn and 14.0％ (6 cases)reflux esophagitis during the followed－ up. Conclusion Endoscopic esophageal balloon dilatation for achalasia is an effective and saf e method not only in the short－ term but also in the long－ term.

Effects of External Nasal Dilators on Nasal Respiration and Patency in Patients with Deformity of the Nasal Septum by Mladina ClaSSIFICATION: An Acoustic Rhinometric Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The external nasal dilator (END) was designed to improve nasal respiration by expanding the nasal valve area and authors have proven in previous reports that the END improves nasal respiration and patency in patient with DSN. The present study attempts to assess the different effects of the END on nasal respiration and patency in DSN patients with dysfunction of the nasal valve area and in those with dysfunction of some other areas. MATERIALS AND METHODS: Fourty-six male patients (ages 18-49, average age 31.5) without any other nasal or sinus disease and who are not classified as Mladina types 1, 4 or 7 were used as subjects. The type of DSN was determined by Mladina classification. Those with dysfunction of the nasal valve area (Type 2) were classited as Group A and those with dysfunction of some other anatomical area as Group B (Type 3, 5, 6). The subjective sensation of nasal respiration, average minimum cross-sectional area (MCA) and nasal volume (V5: nasal volume from 0-5 cm) of all subjects were assessed and compared before and after the application of an END. RESULTS: Subjective sensation of nasal respiration, MCA and V, improved sign ificantly in both groups after the application of an END, but there were no significant differences between the two groups. CONCLUSION: Although an F,ND significantly improves nasal respiration and patency, this effect does not show any significant differences between patients with dysfunction of the nasal valve area and those with dysfunction of some other anatomical areas. This is because ENDs equally affect all Types of septal deformity.

Effects of External Nasal Dilators on Snoring and Obstructive Sleep Apnea in Korean Adults: A Polysomnographic Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It was reported that external nasal dilators (ENDs) can reduce snoring and obstructive sleep apnea (OSA) in white people by dilating the nasal valve area and then, improving nasal breathing. However, there are no available data on Asians, whose geometry of nasal cavities is different from that of white people. The aim of this study is to evaluate the effects of ENDs on snoring and OSA in Korean adults. MATERIALS AND METHODS: Twelve simple snorers (3 female and 9 males, aged 19 to 44 years) and 35 OSA patients (35 males, aged 22 to 65 years) without nasal diseases were included in this study. Polysomnography including measurement of snoring intensity was performed at two separate nights, one with and the other without an END. Averaged maximum snoring intensity, apnea index (AI), respiratory disturbance index (RDI), ratio of deep sleep (stage 3 and 4) to total sleep time, and minimum arterial oxygen saturation (SaO2) with and without an END were measured and compared. RESULTS: Snoring intensity was reduced in 6 (50.0%) of 12 simple snorers and 16 (45.7%) of 35 OSA patients. In overall, snoring improved significantly in both groups. In OSA patients, AI and RDI improved significantly, but ratio of deep sleep time and minimum SaO2 did not. There were no significant correlations between change of snoring intensity and change of AI or RDI in OSA patients. CONCLUSION: These results suggest that ENDs are helpful to improvement of snoring and respiration during sleep, but the sleep stages remain almost unchanged by ENDs in Korean adults with snoring and/or OSA.