Porous titanium-hydroxyapatite composite coating obtained on titanium by cold gas spray with high bond strength for biomedical applications.

The lack of bioactivity of titanium (Ti) is one of the main drawbacks for its application in biomedical implants since it can considerable reduce its osseointegration capacities. One strategy to overcome this limitation is the coating of Ti with hydroxyapatite (HA), which presents similar chemical composition than bone. Nonetheless, most of the strategies currently used generate a non-stable coating and may produce the formation of amorphous phases when high temperatures are used. Herein, we proposed to generate a Ti-HA composite coating on Ti surface to improve the stability of the bioactive coating. The coating was produced by cold gas spraying, which uses relatively low temperatures, and compared to a Ti coating. The coating was thoroughly characterized in terms of morphology, roughness, porosity and phase composition. In addition, the coating was mechanically characterized using a tensile loading machine. Finally, biological response was evaluated after seeding SaOS-2 osteoblasts and measuring cell adhesion, proliferation and differentiation. The novel Ti-HA coating presented high porosity and high adhesion and bond strengths. No change in HA phases was observed after coating formation. Moreover, osteoblast-like cells adhered, proliferated and differentiated on Ti-HA coated surfaces suggesting that the novel coating might be a good candidate for biomedical applications.

Allergic rhinitis causes loss of smell in children: The OLFAPEDRIAL study.

BACKGROUND: The objective of the OLFAPEDRIAL study was to assess the olfactory dysfunction in allergic paediatric population, which has been scarcely studied. METHODS: Observational, cross-sectional and multicentre study evaluated the sense of smell in untreated allergic rhinitis (AR) paediatric patients aged 6-12 years. RESULTS: Forty-four per cent (551 of 1260) of children with AR reported smell dysfunction, with both loss of smell frequency (52.1%, p < 0.001) and intensity (0.75 ± 0.84, p < 0.0001) being more frequent in patients with persistent than intermittent AR (38.0% and 0.51 ± 0.73, respectively). In addition, both loss of smell frequency and intensity increased according to disease severity (m-ARIA classification) but always being significantly higher in persistent (p < 0.0001) than in intermittent AR. CONCLUSIONS: Children with allergic rhinitis present a mild-moderate loss of smell frequency and intensity which is clearly related to the disease duration and severity. The loss of smell can be considered, as in adults, a clinical marker of disease severity.

The loss of smell in persistent allergic rhinitis is improved by levocetirizine due to reduction of nasal inflammation but not nasal congestion (the CIRANO study).

BACKGROUND: Persistent allergic rhinitis (PER) has a moderate impact on the sense of smell, but no controlled study has reported the effect of antihistamines on the loss of smell in patients with PER. METHODS: Patients with PER and subjective loss of the sense of smell (n = 27) were included in this pilot randomised, double-blind, placebo-controlled study. Nasal symptoms, nasal endoscopy, skin prick test, acoustic rhinometry, peak nasal inspiratory flow, nasal nitric oxide (nNO), and olfactometry (Barcelona Smell Test-24; BAST-24) were performed and evaluated in all PER patients at baseline and after 7 and 30 days of treatment with levocetirizine 5 mg or placebo. RESULTS: The study population was randomized into two homogeneous groups: levocetirizine (n = 14) and placebo groups (n = 13). The evolution of symptoms reflected the therapeutic effect of levocetirizine treatment on rhinorrhea, nasal itching, eye itching, sneezing, and the total symptoms score after 7 and 30 days. Significant improvement in loss of smell by a visual analog scale (VAS) was observed after 7 days of levocetirizine treatment (7.2 ± 4.3; p < 0.05) compared to placebo (-9.4 ± 6.2). Improvement in smell identification by BAST-24 was strongly correlated (r = 0.72; p < 0.05) with smell improvement by VAS after 30 days. After 7 days of treatment with levocetirizine, the nNO values decreased (-494 ± 188) compared to placebo (155 ± 284 ppb; p < 0.05). CONCLUSIONS: The CIRANO study suggests that levocetirizine is effective on PER symptoms, including a transient improvement in loss of smell, and that this improvement concurs more with reduction of nasal inflammation than of nasal patency.

Persistent asthma has an accumulative impact on the loss of smell in patients with nasal polyposis.

BACKGROUND: Loss of sense of smell is one of the most frequent complaints in patients with nasal polyposis (NP). The aim of this study was to evaluate the impact of asthma and its severity on the sense of smell. MATERIAL AND METHODS: Patients with massive NP and healthy controls were included. More than half of patients presented with asthma. Olfactometry by Barcelona Smell Test 24, nasal symptoms score, nasal endoscopy, allergy study, and paranasal sinus CT scan were assessed. RESULTS: NP patients showed a significant impairment in smell detection, identification, and forced choice compared to the control. Asthmatics reported lower scores for detection, identification, and forced choice than non-asthmatic patients. Patients with persistent asthma had an increased impairment of sense of smell on detection, identification, and forced choice than patients with intermittent asthma. No significant differences were found between mild, moderate, and severe persistent asthmatics. Paranasal sinuses opacification was inversely correlated with smell detection, identification and forced choice. CONCLUSION: These findings suggest that patients with NP have an impaired sense of smell, that asthma -particularly persistent asthma- has a further impact on sense of smell, and that loss of smell may be used as a clinical tool to identify the severity of both NP and asthma.

The importance of smell in patients with bronchiectasis.

BACKGROUND: The aim of the study was to evaluate the sense of smell in patients with bronchiectasis. METHODS: Prospective controlled study was performed on 91 patients with bronchiectasis. Bronchiectasis patients were sub-classified depending on: the presence of chronic rhinosinusitis, with or without nasal polyps, and the bronchiectasis ethiology. Olfactory function was evaluated by means of the Barcelona Smell Test (BAST-24) olfactometry for detection, identification, and forced choice for the first and fifth cranial nerve dependent odours in comparison to a group of 120 healthy volunteers. RESULTS: Most patients with bronchiectasis (80.2%) satisfied EP(3)OS criteria of chronic rhinosinusitis (CRS), and 26.4% presented nasal polyps (NP). Smell detection, identification, and forced choice tests were significantly (p < 0.001) worse in bronchiectasis patients than healthy controls for both the 1st and 5th CN. Among subgroups, patients with CRS presented a significant (p < 0.05) reduction in smell detection compared to both healthy controls and patients without CRS. Patients with both CRS and NP presented a significant (p < 0.01) reduction in both smell detection and forced choice compared to patients with CRS and without NP. Patients with bronchiectasis and primary humoral immunodeficiency had a poorer smell detection (p < 0.001) and forced choice (p < 0.001) compared with post-infective and idiopathic bronchiectasis patients. CONCLUSIONS: Patients with bronchiectasis have a moderate loss of smell with a higher impairment in patients with CRS, being maximal in patients with NP. Patients with immunodeficiency bronchiectasis showed high prevalence of CRS, and therefore marked impairment on the sense of smell. The mechanism could be explained through a mixed ethiology (obstruction/inflammation).

Controversies in the treatment of chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) including nasal polyps is a chronic inflammatory disease involving the mucosa of the nose and one or more paranasal sinuses. Despite differing hypotheses, the cause remains poorly understood. The key issue is the maintaining of ostial patency. CRS with nasal polyps is considered to be a subgroup of CRS. Major symptoms are nasal congestion or blockage, loss of smell, rhinorrhea, post-nasal drip, and facial pain or pressure. CRS is associated with lower airway disease such asthma, chronic obstructive pulmonary disease and bronchiectasis. In CRS with and without nasal polyps, medical treatment, including nasal and oral corticosteroids, is the first therapeutic option. The treatment of CRS still remains an unmet need. Corticosteroids are the mainstay of treatment and are the most effective drugs for treating airway inflammatory diseases such as asthma, allergic rhinitis and CRS. Endoscopic sinus surgery is only recommended when medical treatment fails. After surgery, medical treatment, including nasal and oral corticosteroids, is recommended.

Persistent allergic rhinitis has a moderate impact on the sense of smell, depending on both nasal congestion and inflammation.

OBJECTIVES/HYPOTHESIS: A degree of smell disturbance has been found in seasonal and perennial allergic rhinitis, but alterations in olfaction in patients with persistent allergic rhinitis (PER) have not yet been evaluated. The aims of the study were to evaluate the impact of PER on the sense of smell, and to characterize this impact based on self-reported hyposmia (SRH) and PER severity. STUDY DESIGN/METHODS: A prospective controlled study was performed on 49 consecutive patients with PER. PER patients were subclassified depending on severity and the presence of SRH. Olfactory function was evaluated by the Barcelona Smell Test-24 (BAST-24) olfactometry for smell detection, identification, and forced choice for first and fifth cranial nerve (CN) dependent odors in comparison to a group of 60 healthy volunteers. In patients with SRH, obstruction was evaluated by peak nasal inspiratory flow (PNIF) and acoustic rhinometry; and nasal inflammation was evaluated by nasal nitric oxide (nNO). RESULTS: Most patients with PER (67%) presented SRH. Moderate/severe PER (84.8%) predominated among patients with SRH, while mild PER (75%) predominated among patients without SRH. Smell detection, identification, and forced choice tests were significantly worse in PER patients (P < .05) than in healthy controls for the odors related to the first and fifth CN. Among subgroups, patients with moderate/severe PER and/or with SRH presented a significant reduction in smell detection (P < .05) compared to healthy controls. Nasal NO correlated (R: 0.4; P < .05) with loss of smell. CONCLUSIONS: Patients with PER have a moderate loss of smell (BAST-24) with a higher impairment in those with self-reported hyposmia and moderate-to-severe PER. These results suggest that the sense of smell should be further investigated in all patients with allergic rhinitis, both in a clinical setting and in clinical trials.

El riesgo de meningitis bacteriana ascendente en los defectos de la base anterior de cráneo y su manejo quirúrgico / Risk of Ascending Bacterial Meningitis in Anterior Skull Base Defects and Their Surgical Management

El abordaje endoscópico de las fístulas de líquido cefalorraquídeo (FLCR) ha quedado acreditado en numerosas publicaciones. Pero a pesar del riesgo de una FLCR de desarrollar meningitis bacteriana a corto y a largo plazo, sigue la controversia acerca de si hay que intervenir o nopara sellar la FLCR o reconstruir el defecto de la base anterior del cráneo. Material y métodos: Revisión bibliográfica y de casuística propia que avale la cirugía endoscópica mínimamente invasiva en todos los casos constatados de defectos de la base anterior del cráneo, con o sin FLCR, con la finalidad de evitar una meningitis bacteriana ascendente. Se desarrolla la técnica quirúrgica de reconstrucción de defectos de la base anterior del cráneo, y se explican los pormenores y algunos trucos que la facilitan. La tasa de meningitis bacteriana como consecuencia de traumatismos craneoencefálicos es alta, entre un 18 y un 30%, y no decrece con el tiempo. Si se incluyen los casos que repiten meningitis, la tasa puede alcanzar hasta un 85%. En nuestra casuística, 9 de 27 pacientes desarrollan una meningitis postraumática, 5 de ellos, repetida. En el grupo de defectos de la base anterior del cráneo de diversos orígenes, 15 de 39 pacientes tuvieron meningitis antes del cierre quirúrgico. Después de la reparación endoscópica y con una media de 56 meses de seguimiento (rango, 16- 120), ninguno de ellos vuelve a tener meningitis bacteriana, así como tampoco ninguno de los pacientes que no la habí- an presentado. La tasa de cierre en pacientes operados por primera intención es del 97,5% y con repesca del 100% (...) (AU)

Risk of Ascending Bacterial Meningitis in Anterior Skull Base Defects and Their Surgical Management The endoscopic approach in cerebrospinal fluid (CSF) fistulas has been validated in numerous papers. However, the need to correct CSF leaks or repair defects of the anterior skull base remains controversial, even though there is an evident short- and long-term risk of ascending bacterial meningitis. Material and methods: We performed a systematic review of the literature on the risks and/or rates of bacterial meningitis after trauma or anterior skull base surgery. We also reviewed the results in our series of patients with anterior skull base defects, with or without CSF leaks, to assess the rate of preventable ascending bacterial meningitis. The surgical technique for endoscopic skull base repair is described, including maneuvers that might help to improve outcomes. The rate of posttraumatic primary meningitis is high (between 18% and 30%) and does not decrease with time. Moreover, if cases of recurrent bacterial meningitis are included, this rate increases to 85%. In our series, nine out of 27 patients developed ascending bacterial meningitis after trauma, five of which were recurrent. In a series of 39 patients who underwent surgery for anterior skull base defects of different origin, 15 had previously suffered from bacterial meningitis. After endoscopic skull base repair, with a mean follow-up of 56 months (range 16- 120 months), none of these patients developed meningitis, nor did any of those who had not had meningitis before surgery. The overall rate of successful primary endoscopic skull base repair was 97.5% and was 100% after revision surgery. The complications rate of endoscopic repair of anterior skull base defects is very low. Endoscopic skull base repair of defects with or without CSF leak seems to prevent ascending bacterial meningitis (...) (AU)

Angiofibroma juvenil / Juvenile Angiofibroma

El angiofibroma juvenil (AJ) es un tumor benigno de la edad infantil y el sexo masculino. En las publicaciones recientes se relacionan los AJ con cambios genéticos y algunos estudios apuntan a que se trata de una malformación vascular. Su crecimiento es por expansión local lentamente progresiva; se inicia en la zona del basiesfenoides y el foramen esfenopalatino, y puede llegar a la fosa infratemporal, el seno cavernoso y el endocráneo. Su aporte vascular procede mayormente de la arteria maxilar. La clínica es anodina, de obstrucción nasal y epistaxis de repetición. La tomografía computarizada y la resonancia magnética (RM) son necesarias para estudiar la extensión y planificar el abordaje quirúrgico, la RM es imprescindible para el seguimiento. Respecto al abordaje quirúrgico hubo un cambio de paradigma en la última década: se considera subsidiario de cirugía endoscópica en los estadios I y II de Fisch, para algunos autores, incluso en el IIIA. La tasa de recidivas es más favorable que la observada con abordajes externos. Con ello se ha reducido considerablemente la morbilidad relacionada con los abordajes externos, que se reservan para extensiones mayores. La cirugía se ha visto facilitada por la embolización previa de la tumoración, capaz de reducir el sangrado intraoperatorio. Las tasas de recidivas/persistencias no se han visto incrementadas por la cirugía endoscópica. El artículo presenta una visión general de los angiofibromas y se discute los resultados propios y ajenos de la cirugía endoscópica (AU)

Juvenile angiofibroma (JA) is a benign tumor associated with young males. Recent studies have associated JA with genetic changes, while others suggest that this entity is a vascular malformation. These tumors grow through slowly progressive local extension, starting at the basisphenoid and the sphenopalatine foramen. Invasion into the infratemporal fossa, the cavernous sinus or intracranial region may occur. The vascular supply comes mainly from the internal maxillary artery. There are no typical symptoms; however, unilateral nasal obstruction and recurrent epistaxis are present. Computed tomography scan and magnetic resonance imaging (MRI) are required to assess tumoral extension and to plan the surgical approach. MRI is mandatory to assess tumoral recurrence during follow-up. In the last decade a change in the surgical paradigm has taken place. Most authors now consider Fisch stages I and II to be removable by the endoscopic approach and some authors even use this approach with type IIIA tumors. The recurrence rate is lower with the endoscopic approach than with external approaches. Thus, the high morbidity associated with external approaches has been considerably reduced, and these approaches are now reserved for extensive JA. Preoperative embolization diminishes intraoperative bleeding, enabling piecemeal resection. Rates of recurrence or persistence have not been increased by endoscopic procedures. The present article provides an overview of JA and discusses our own results with endoscopic approaches, as well as those of other authors (AU)

Cerebellopontine angle and internal auditory canal metastasis from ductal carcinoma of the breast.

This is the first formal case report of internal auditory canal and cerebellopontine angle metastasis from infiltrative ductal carcinoma of the breast. Only three previous cases have been reported of isolated metastasis in the cerebellopontine angle and internal auditory canal from breast cancer. Currently, no therapeutic guidelines for isolated metastasis from breast cancer in this location exist. We report a case and review the current literature in order to help characterize the clinicopathologic features and management. A 72-year-old female with a 5-year history of left infiltrative ductal carcinoma of the breast reported progressive left-sided facial palsy and ipsilateral hearing loss accompanied by the development of tinnitus and unsteadiness during the previous 3 months. MRI identified a lesion in the cerebellopontine angle and internal auditory canal. The lesion was completely excised via a retrosigmoidal approach and adjuvant radiotherapy was used subsequently. The patient remains well 18 months after treatment, with no evidence of recurrence on repeat MRI. The rapid evolution of symptoms involving the Vth, VIIth or VIIIth cranial nerve, or multiple cranial nerves, is suggestive of a malignant lesion of the cerebellopontine angle and/or internal auditory canal. A previous history of neoplasm is important due to the possibility of a metastasis. Cerebellopontine angle metastasis can be found many years after the initial diagnosis of breast neoplasm. Surgery and adjuvant radiotherapy seems to be a good choice for the treatment of patients with this specific type of metastasis.

The impact of asthma and aspirin sensitivity on quality of life of patients with nasal polyposis.

BACKGROUND: Nasal polyposis is not a life-threatening disease but may have a great impact on patient's quality of life. OBJECTIVE: To investigate the impact of nasal polyps on quality of life compared with the Spanish general population using the SF-36 questionnaire; and to evaluate the impact of asthma and aspirin sensitivity on quality of life in patients with nasal polyposis. METHODS: We included 130 patients with nasal polyposis and evaluated nasal symptom, CT scan, polyp size, and quality of life. RESULTS: In comparison with the Spanish general population, patients with nasal polyposis had worse scores on all SF-36 domains except for physical functioning. Asthmatic patients with nasal polyposis had worse quality of life than nonasthmatic patients on role physical, body pain, and vitality (p < 0.05). The authors found no significant differences on quality of life, nasal symptoms, polyp size, and CT scan scores between patients with aspirin-tolerant and aspirin-sensitive asthma. CONCLUSION: These results suggest that nasal polyposis has a considerable impact on quality of life. Moreover, asthma but not aspirin sensitivity has an additional negative impact on the quality of life of patients with nasal polyposis.

Inflammatory myofibroblastic tumor in the larynx: clinicopathologic features and histogenesis.

Inflammatory myofibroblastic tumor is extremely rare in the larynx and can mimic a malignant process. We present the case of a 62-year-old male who required tracheotomy due to rapidly progressive stridor. Laryngoscopy showed an exophytic, occlusive tumor located in the right true vocal cord. CT showed an expansive mass measuring 2 x2 x1.3 cm3 and occupying the anterior commissure, with glottic progression to the right true vocal cord. The tumor was completely resected with a CO2 laser via a transoral approach. Histologic examination demonstrated extensive ulceration with the presence of granulation tissue. The specimen was mainly composed of spindle cells arranged in a fasciculated pattern with a myxoid background and focal hyalinization. Immunohistochemical studies revealed positivity of spindle cells to vimentin, muscle-specific actin and smooth muscle actin. The patient showed no evidence of disease 24 months after surgery.

Peripheral primitive neuroectodermal tumor of the cerebellopontine angle.

Peripheral primitive neuroectodermal tumors are highly malignant small cell neoplasms. A 27-year-old female presented with a 6-month history of right-sided facial pain and progressive weakness of the facial muscles. She had non-pulsative tinnitus, progressive right hearing loss and facial palsy. T2-weighted MRI showed a heterogeneous hyperintense lesion invading the right internal auditory canal. Surgical removal was performed. Pathological examination showed sheets of small cells with irregular nuclei. Immunohistochemical studies demonstrated positive immunoreactivity for neuron-specific enolase, synaptophysin, chromogranin, vimentin, S-100 protein and p30-32 MIC-2 gene product. The patient was treated with chemotherapy (etoposide, vincristine, adriamycin, ifosfamide and actinomycin D) and radiotherapy. After 65 months of follow-up, the patient presented with cervical metastasis. Radical cervical dissection was performed and the patient was treated with a second course of chemotherapy. At control MRI after 29 months of follow-up the patient showed no signs of local recurrence or distant metastasis.

Orbitoethmoid aneurysmal bone cyst. Case report and literature review.

Aneurysmal bone cyst is a benign, vascular, variable growing and expansive lesion that can occur in any part of the skeletal system, but mainly in long bones and vertebrae. We present a case of orbitoethmoid aneurysmal bone cyst in a 62-year-old female presenting epiphora. Nasal endoscopy was normal. Sinus CTscan revealed an expansive mass in the right ethmoid sinus extending and destroying the right lamina papiracea. The tumor was completely resected through paralateral rhinotomy. Histological analysis showed fibrous septa containing multinucleated giant cells and bone tissue surrounding blood vessel lumens, bordered by endothelial cells. These findings are characteristic of aneurysmal bone cysts. After 30 months of postoperative follow-up the patient remains disease-free and asymptomatic.

Transoral approach to drain streptococcus pneumoniae spinal epidural abscess in an HIV-infected adult.

Spinal epidural abscess due to Streptococcus pneumoniae is extremely rare in adults. It typically occurs in the thoracic, lumbar or lumbosacral epidural spaces, and less frequently in the cervical epidural space. The principal causative microbial agent is Staphylococcus aureus, representing 70% of cases, while 1.6% of cases are caused by S. pneumoniae. We report the first case of an HIV-infected patient with a cervical spinal epidural abscess. The patient was a 43-year-old male with pneumococcal bacteremia and a metatarsal abscess. He reported cervical pain with muscle spasm during cephalic flexion and extension, fever and a painful tumefaction on the second metatarsal of the left foot. MRI confirmed that the retropharyngeal abscess extended to the cervical spinal epidural space. Antibiotic therapy with cefotaxime plus vancomycin was initiated and a transoral surgical approach was used to achieve retropharyngeal and local debridement of the metatarsal abscess. Blood and pus cultures were positive for S. pneumoniae. After 4 months of follow-up the patient remained asymptomatic, without clinical or MRI evidence of recurrence.

Nasal manifestations of systemic illnesses.

This article is focused on the nasal and sinusal manifestations of systemic diseases, such as infections, immunodeficiencies, chronic multisystemic disorders, inflammatory bowel diseases, deposition diseases, hematologic diseases, respiratory diseases, and smell and taste disorders. A concise review of some of the systemic diseases that commonly present complaints in the nose and paranasal sinuses, including their prevalence, sinonasal manifestations, diagnosis, and treatment, is provided.

Extranodal lymphoma originating from mucosa-associated lymphoid tissue of the nasopharynx.

Non-Hodgkin's lymphoma originating from mucosa-associated lymphoid tissue has been connected with autoimmune disease. These tumours often arise in gastric mucosa and are extremely rare in airway mucosa. Three cases of mucosa-associated lymphoid tissue lymphoma in the cavum have been reported in the literature. A 52-year-old male with rheumatoid arthritis presented with an 8-month history of nasal obstruction and recurrent nasal blood discharge. On physical examination a bulky mass was observed in the nasopharynx. CT demonstrated a soft tissue lesion in the nasopharynx without bone destruction. MRI showed a contrast-enhanced mass with extension to the left pterygoid muscle. Biopsy revealed a low-grade B-cell lymphoid tumour of the marginal zone. The patient received six cycles of cyclophosphamide, vincristine and prednisone with adriamycin treatment, together with intracranial methrotrexate as a prophylactic measure. After 48 months of follow-up there was no evidence of disease and a control MRI scan was normal. The prognosis of this type of tumour is unpredictable and there are too few cases to enable definitive conclusions to be drawn.