Eight weeks of omeprazole 20 mg significantly reduces both laryngopharyngeal reflux and comorbid chronic rhinosinusitis signs and symptoms: Randomised, double-blind, placebo-controlled trial.

OBJECTIVES: Gastroesophageal reflux recommended treatment (dose and duration) with proton-pump inhibitor (PPI) compared to placebo significantly reduces the signs and symptoms of laryngopharyngeal reflux (LPR) and comorbid chronic rhinosinusitis (CRS). DESIGN: Double-blind randomised placebo-controlled trial. SETTING: Eight weeks of treatment with omeprazole 20 mg once daily (OD). PARTICIPANTS: Sixty patients (28 women, aged 19-87 years) with diagnosed LPR and comorbid CRS. MAIN OUTCOME MEASURES: Significant reduction in signs and symptoms (reflux symptom index (RSI) score as subjective, and reflux finding score (RFS) as objective measure) of LPR after 8 weeks of treatment with omeprazole 20 mg OD when compared to placebo. Secondary objectives were significant reduction in signs and symptoms of comorbid CRS after 8 weeks of treatment with omeprazole 20 mg OD when compared to placebo and the association of the severity of signs and symptoms of LPR with the ones of CRS. RESULTS: RSI and RFS decreased significantly more in the active treatment group after 8 weeks compared to placebo (P < .001 for both). CRS and endoscopy scoring decreased both significantly more in the active group after 8 weeks compared to placebo (P < .001 for both). CRS scoring significantly correlated with RSI (R = 0.312, P = .015) but not with RFS (R = 0.199, P = .127). CONCLUSIONS: The results of our trial suggest that omeprazole 20 mg OD for 8 weeks was effective in reducing signs and symptoms of both LPR and CRS, although in most patients still present at the end of the trial.

Measurement of flow of thought in 68 patients monitored in post-emergency outpatient consultations: Role of ideational turmoil in the anxiety depressive symptomatology.

INTRODUCTION: Rumination, cognitive control deficits, cognitive saturation, and loss of inhibition are the major hypotheses used to explain depressive disorders. A few studies have nevertheless looked at the form of thought. In this study, we will test a double measurement of the number of thoughts and a double measurement of the flow of thought together with their correlation with well-being, mental pain, and depression. MATERIAL AND METHODS: Between May and September 2015, 68 subjects, initially admitted as emergencies for acute anxiety depressive disorders and/or suicide attempts and subsequently monitored as post-emergency outpatients in medico-psychological consultations agreed to complete a set of Visual Analogue Scales measuring their well-being, their mental pain, their estimated number of thoughts and the how agitated these thoughts are estimated to be. A double evaluation of the cognitive activity consisted of representation intrusive thoughts by filling a drawing of an aquarium to reflect the number of thoughts (by drawing fish) and cognitive turmoil (by drawing wavy lines). The depressive illness was evaluated using the Beck depression inventory and by rater-administered assessments using MADRS (Montgomery-Asberg Depression Scale). RESULTS: These measurements are of good psychometric quality (sensitivity, accuracy, validity). The mental pain is related to mental turmoil. These results reveal positive correlations between the mental turmoil and the total score on the depression. The use of the aquarium makes it possible to distinguish the feeling of having "a lot of thoughts" from the feeling of having "agitated thoughts". So, the total score of wavy lines shows positive correlation with the total score on the depression inventory (BDI) and the total MADRS score. DISCUSSION: The results suggest that the phenomena of cognitive saturation and the sensation of mental restlessness play a major role in the etiopathogensis of depression. The analyses show that the cognitive dysregulation is situated more precisely at the level of the flow of thought rather than the level of the number of thoughts. A deterioration in the flow of thought increases the mental pain and the depressive symptoms, and reduces well-being. The sample is nevertheless small, and some bias appears in the filling of the aquarium boxes.

Idiopathic epistaxis and meteorological factors: case-control study.

OBJECTIVE: The aim of this study was to determine the relationship between the occurrence of idiopathic epistaxis and daily values of air pressure, temperature, and humidity. We also investigated whether biometeorological forecasts should be addressed to persons with a history of nosebleed diathesis. METHODS: We analyzed consecutive idiopathic epistaxis events over a 3-year period. Patients were included if they had been in the municipality of Mostar, Bosnia and Herzegovina at least 24 hours before the epistaxis occurrence. The monthly variation in epistaxis events was determined. Epistaxis days (Days "0", 0 = day with epistaxis occurrence) and selected nonepistaxis days (Days "-1", -1 = each first single day without epistaxis prior to Day 0) were compared according to daily values of mean, minimum, and maximum temperature; diurnal temperature range; minimum and maximum atmospheric pressure; diurnal pressure range; and mean relative humidity. RESULTS: The greatest and smallest percentage of epistaxis events occurred in the months of March and August, respectively. There were no significant differences between Days 0 and Days -1 with respect to the examined meteorological factors. CONCLUSION: In this region with a Mediterranean climate, we found a seasonal variation with an incidence peak during the spring transition months, but we did not identify any meteorological trigger factors for epistaxis. Thus, there is no need for biometeorological forecasts to be addressed to persons with a history of nosebleed diathesis.

Algorithm for navigated ESS.

ENT navigation has given new opportunities in performing Endoscopic Sinus Surgery (ESS) and improving surgical outcome of the patients` treatment. ESS assisted by a navigation system could be called Navigated Endoscopic Sinus Surgery (NESS). As it is generally accepted that the NESS should be performed only in cases of complex anatomy and pathology, it has not yet been established as a state-of-the-art procedure and thus not used on a daily basis. This paper presents an algorithm for use of a navigation system for basic ESS in the treatment of chronic rhinosinusitis (CRS). The algorithm includes five units that should be highlighted using a navigation system. They are as follows: 1) nasal vestibule unit, 2) OMC unit, 3) anterior ethmoid unit, 4) posterior ethmoid unit, and 5) sphenoid unit. Each unit has a shape of a triangular pyramid and consists of at least four reference points or landmarks. As many landmarks as possible should be marked when determining one of the five units. Navigated orientation in each unit should always precede any surgical intervention. The algorithm should improve the learning curve of trainees and enable surgeons to use the navigation system routinely and systematically.

[Dynamic of ideation and preparatory behavior in the suicidal act: concerning a standardised and qualitative methodology]. / Dynamique de l'idéation et des comportements préparatoires dans le passage à l'acte suicidaire: vers une méthodologie qualitative standardisée.

Suicidal risk factors are nowadays well known. We often detect many of these risk factors in clinical situations, but their interaction and their writing in the suicidal sequence are still largely unrecognized. Building on narratives from suicidal patients, the authors propose a method for investigating the upstream components of suicide in an attempt to understand how the risk factors and the state of the person interact and converge on the suicidal action better. The interview is divided into the following four sections. (1)The patient is invited to mentally go back to the hours immediately preceding the suicide attempts and reconstruct the sequence of thoughts, feelings and doings of the day. Here, we explore the dynamic progression of his cognitions, emotions, actions and state of consciousness. We also note the social affective context of the suicidal act. (2) Proceeding backwards into the memory, the patient is invited to retrieve all foreshadowing elements, situating them on two axes: behavioural planning, that is, effective or contemplated actions in relation to suicide (stocking drugs, seeking information about substance toxicity, weapon training, etc.). (3) The second axis focuses on the phenomenology of the suicidal ideation, that is, intensity, frequency, proximity/availability of suicidal ideation, etc. These are assessed by means of an analogical rule. Finally, the current attempt is situated in the context of the suicidal history of the patient: previous attempts, severity, operative mode, etc. Our clinical experience using this semi-structured interview has shown that the method gives an insight into the unique combination of factors leading to the suicidal act in a given person and permits to understand and foresee relapses better. A new model of suicide is emerging from our data, suggesting the importance of the preparatory phase, which combines a progressive non-conscious learning of the gestures to accomplish, rumination of suicidal ideations and alteration of consciousness and the sense of self. The method is illustrated through an example. The necessity to further test this interview method is called for.

Capsaicin significantly reduces sinonasal polyps.

Some reports indicate that topical nasal treatment with capsaicin, which is usually effective in reducing symptoms of vasomotor rhinitis, may also reduce symptoms in patients with nasal polyps. The aim of this study was to investigate the effect of topical capsaicin treatment in severe sinonasal polyposis. Nine non-allergic, non-asthmatic patients with diffuse eosinophilic nasal polyposis were subjected to topical capsaicin treatment: for 3 consecutive days 0.5 ml 30 micromol/l capsaicin solution and on days 4 and 5 100 micromol/l capsaicin solution was sprayed into each nostril. Coronary computed tomography (CT) images were made shortly before treatment. Baseline nasal lavages and a questionnaire containing subjective symptoms and nasal endosocpy were taken just prior to the first application. Nasal lavages were performed prior to and after the last treatment and over 4 weeks, endoscopy and subjective scores at each weekly visit, and correspondent CT scans 4 weeks after the treatment. CT images were analysed by computer, calculating the nose sinuses air volume (NSAV) from the surface of aerated parts of nasal and sinus cavities for each slice per patient prior to and after treatment. Statistical analysis was performed comparing NSAV, subjective scores, endoscopy scores and eosinophil cationic protein (ECP) levels in nasal lavages prior to and after treatment. Topical treatment with capsaicin significantly increased NSAV and very significantly improved subjective and endoscopy scores, but did not significantly alter ECP levels in nasal lavages.

Effect of cromolyn pre-treatment on capsaicin-induced rhinitis in rats.

The effect of cromolyn sodium local pre-treatment on capsaicin-induced rhinitis in rats was studied by analyzing tissue changes due to edema, inflammatory cell infiltration and IgA upregulation. Nasal mucosa samples were stained with hematoxylin-eosin and examined immunohistochemically with monoclonal IgA antibodies. Changes were analyzed at 6, 12 and 72 h after capsaicin treatment and were scored semiquantitatively. Results showed that local cromolyn pre-treatment modified all parameters observed in the nasal mucosa following capsaicin-induced rhinitis in the rats.

Distilled water nasal provocation in hyperreactive patients.

Nonisotonic aerosol may act as a provocation agent in the upper and lower airways of hyperreactive individuals. The purpose of the study was to compare the results of nasal challenge with distilled water in patients with allergic rhinitis to those with noninfective nonallergic rhinitis (NINAR), with respect to the potential clinical use of the obtained data. A group of 68 ambulatory patients with allergic rhinitis or NINAR (39 perennial allergic, 6 seasonal, 23 NINAR) were challenged with 10 mL of distilled water aerosol after the baseline active anterior rhinomanometry. Patients with nasal polyposis at endoscopy, significant unilateral septal deviation, positive bacteriologic swab, recent nasal surgery, and uncertain anamnestic data about the medication taken 6 weeks before the provocation were excluded from the study. After 10 minutes of nasal provocation, rhinomanometry was repeated to assess the response. In 15 patients of the perennial allergic group, the same measurements were performed after a 2-week oral antihistamine and topical steroid therapy. Nasal resistance was significantly increased on the more patent side of the nose after nasal provocation with distilled water aerosol in allergic patients in comparison to the nasal resistance before provocation. In the patients with NINAR, the provocation resulted in a significant rise on the more patent side, but the total nasal airway resistance (NAR) levels were also significantly increased. The systemic antihistamine and topical steroid 2-week therapy in patients with perennial allergic rhinitis significantly reduced the response to nasal distilled water provocation. Nasal provocation with distilled water aerosol is a cheap, simple, and acceptable method that provides useful clinical data on the level of nonspecific nasal hyperreactivity and the therapy success.

Dose-dependent protective effect of BPC 157 on capsaicin-induced rhinitis in rats.

Protection of BPC 157 on capsaicin-induced rhinitis was studied in Wistar rats for its effect on mastocyte infiltration, degranulation and inflammatory cell infiltration. Animals were pretreated with 10 microg/kg, 10 ng/kg or 2 ml saline i.p. and capsaicin (0.05 ml/nostril of 1750 nmol/l sol.) was applied intranasally. They were then euthanized at 1, 3 and 12 h after capsaicin provocation. Nasal mucosa was analyzed and scored for mastocyte infiltration, degranulation and inflammatory cell infiltration. BPC 157 pretreatment significantly prevented mastocyte infiltration at 1 h. Polymorphonuclear leukocyte infiltration was significantly reduced in rats pretreated with 10 microg/kg BPC 157. A dose-dependent effect of BPC 157 pretreatment was demonstrated only for polymorphonuclear leukocyte infiltration at 12 h.