[Functional-aesthetic rhinosurgery patients: psychometric parameters]. / Patienten mit dem Wunsch nach einer funktionell-ästhetischen Nasenoperation: Psychometrische Parameter.

BACKGROUND: The aim of this study was to acquire psychometric parameters in patients desiring functional-aesthetic nasal surgery. MATERIAL AND METHODS: Over a 1-year period, 101 patients were consecutively examined at the ENT department of the University of Ulm. Septoplasty or septorhinoplasty was indicated in all cases. The acquisition of psychometric data was performed by means of standardised and validated questionnaires. Data relating to anxiety, depression, private and public self-awareness as well as general satisfaction with oneself and in particular with one's nose was collected. RESULTS: Patients demonstrated greater levels of fear, self-awareness in public and dissatisfaction with their nose. The greatest expectation concerning the outcome of the operation was the improvement of nasal obstruction. Altering the outward appearance of the nose was a secondary consideration. CONCLUSION: The screening presented here enables ENT surgeons to identify possible "problem" patients before functional-aesthetic nasal surgery.

Detection of particles within the nasal airways before and after nasal decongestion.

Cleansing of the air is one of the most important functions of the nose. The aim of this investigation was to determine the influence of decongestion of the nasal mucosa with xylometazoline on the intranasal particle deposition at different sites of the nasal cavity. During respiration of an aerosol of starch particles, the non-deposited particles in the air were laseroptically detected in 10 healthy volunteers by a transnasally placed suction probe at different locations within the nasal cavity. The anterior nasal segment was the main area of intranasal particle deposition before and after decongestion of the nasal mucosa. Particle deposition after nasal decongestion was not significantly different from the values before application of xylometazoline. Decongestion of the nasal mucosa and increase in nasal cavity diameter seems not to influence particle deposition of inhaled and exhaled air within a short period after onset of the maximal decongestive effect of xylometazoline.

Leiomyosarcoma of the ethmoidal cells.

Leiomyosarcomas of the paranasal sinuses are rare malignant tumors. A case of a 68-year-old female with leiomyosarcoma of the ethmoidal cells is presented. Since half a year she had a stuffed nose on both sides. Preoperatively, several attacks of epistaxis on the right side occurred. CT scans showed a tumor of the ethmoidal cells on the right side. The tumor was completely removed via a functional endoscopic endonasal approach and right sphenoethmoidectomy and maxillary sinus surgery. The operation was followed by a radiotherapy with 72 Gy. Up to 29 months after the operation local recurrence could not be observed. Endonasal tumor resection followed by radiotherapy in a case of leiomyosarcoma without invasion of orbit and skull base can allow tumor control.

[Endonasal temperature and humidity profile after exposure to various climate-controlled inspiratory air]. / Endonasales Temperatur- und Feuchteprofil nach Exposition zu verschieden klimatisierter Einatemluft.

BACKGROUND AND OBJECTIVE: The nose as the first segment of the upper respiratory tract is exposed to different climatic conditions of the ambient air. The purpose of this study was to determine whether nasal air conditioning of ambient air is influenced by a short-term exposure to air of different climatic conditions. PATIENTS AND METHODS: Fifteen healthy volunteers were enclosed into the study. A miniaturised humidity sensor and thermocouple was used for detection of humidity and airway temperature at three detection sites within the anterior nasal cavity. Both parameters were measured at the end of inspiration during breathing of ambient air after exposure to cold dry air, "normal" ambient air, and warm humid air for 10 minutes. RESULTS: The end-inspiratory intranasal humidity during breathing of ambient air increased at all locations within the nose when the temperature and humidity of the exposure condition increased. At the most anterior detection site, the effect of increase in humidity after exposure to the different climatic conditions was the most pronounced. The increase in intranasal temperature had no relation to the different climatic conditions during the short-term exposure. CONCLUSIONS: The results suggest that nasal humidification in ambient air can be influenced by short-term exposure to air of extreme temperature and humidity prior to breathing of ambient air.

[Rational diagnosis of pediatric pharyngeal abscess]. / Rationelle Diagnostik kindlicher Halsabszesse.

BACKGROUND: Diagnostic procedures intend to differentiate superficial cervical abscesses from deep abscesses and uncomplicated lymphadenitis. They should provide identification of the causing agent, of the route of infection and of possible underlying diseases. Present techniques for examining pediatric cervical abscesses should be assessed. METHODS: Currently published data on diagnostic procedures in pediatric neck abscess from National Library of Medicine data files were evaluated. Moreover, clinical findings, diagnostic procedures, therapy and outcome of 47 children with cervical abscess treated from 1992-1996 were retrospectively evaluated. RESULTS: Studies providing appropriate evidence on the value of various diagnostic procedures in pediatric cervical abscesses were not found. In 47 patients with confirmed cervical abscess treated at our department, clinical examination, erythrocyte sedimentation rate and ultrasound examination of the neck were sufficient to establish the correct diagnosis. Additional investigations such as MRI or CT-scans, chest X-rays, Mendel-Mantoux test, various virus titres and other laboratory examinations were performed only in selected cases. The route of invasion (tonsil, dental or otogeneous) could be identified in 13 children. In 4 children an infected cervical cyst was found. CONCLUSIONS: Clinical examination, erythrocyte sedimentation rate and sonography are appropriate to establish the diagnosis of pediatric cervical abscess and in accordance with the principles of Managed Care.

Heating of air in the nasal airways in patients with chronic sinus disease before and after sinus surgery.

The main goal of this study was to determine the influence of sinus surgery on the heating of inspired air in the nose. Intranasal temperature values of 22 patients with chronic sinus disease were measured after inspiration at different locations in the nasal cavity. Measurements were done before and 6-8 weeks after sinus surgery. The patients were compared to 22 healthy control subjects. Nasal airway temperature did not differ between the two study groups at any location in the nasal cavity. Nasal decongestion was without significant influence on temperature values in the patients and the volunteers. There was no significant difference of nasal airway temperature before and after sinus surgery. Even after sinus surgery the main area of heating of inspired air seemed to be the anterior part of the nose. Sinus surgery in patients with chronic sinus disease does not seem to influence heating of air in the nasal cavity.

[Warming inhaled air in the nose]. / Erwärmung der Atemluft in der Nase.

BACKGROUND AND OBJECTIVE: The purpose of this study was to determine whether the temperature at the end of inspiration is the same as the temperature a few seconds after breathing stops at the end of inspiration to study if the nasal mucosa are capable of providing heat during a cessation of breathing. PATIENTS/METHODS: Fifteen healthy volunteers were included in the study. The temperature at the end of inspiration was compared to the temperature obtained 5 s after cessation of breathing at the end of inspiration and at the end of expiration. Intranasal temperature measurements were taken at three locations in the nose with a miniaturized thermocouple. RESULTS: The temperature increased during cessation of breathing at all locations. The highest temperature differences between the end of inspiration and 5 s later (breathing at rest) could be observed at the nasal valve area. The lowest temperature difference was found in the nasopharynx. At the end of expiration,the temperature decreased only slightly from the nasopharynx to the nasal valve area. CONCLUSIONS: The anterior part of the nose in particular is capable of heating the inspired air. This is also important for humidification. Heating of inspired air requires special anatomical conditions of the anterior nasal segment.

Temperature and humidity profile of the anterior nasal airways of patients with nasal septal perforation.

INTRODUCTION: The most frequent symptoms of patients with nasal septal perforations are crusting and bleeding. The aim of this study was to determine the influence of septal perforations on temperature and humidity of the anterior nasal airways. PATIENTS AND METHODS: Intranasal temperature and humidity were measured in the nasal valve area, the anterior turbinate area and in the nasopharynx during normal respiration. A miniaturized thermocouple and a humidity sensor were used for continuous detection. Ten patients with septal perforations were enclosed into the study. The results were compared to matched healthy control subjects. RESULTS: There were no significant differences of the temperature and humidity values between the left and right side of the nasal cavity in each study group. At the end of inspiration, nasal air temperature did not differ significantly between the two study groups. The humidity values at the end of inspiration were statistically significantly lower in the patient group. CONCLUSIONS: Nasal septal perforations seem to be related to lower humidity in the anterior nasal airways during inspiration. Reduced humidity may contribute to crusting as a main symptom.

Humidity and temperature profile in the nasal cavity.

OBJECTIVES/HYPOTHESIS: Adequate air conditioning in the nasal airways is mandatory for respiration and gas exchange in the lower respiratory tract. The aim of the present study was to measure relative humidity and temperature in the airstream at different sites within the nasal cavity for mapping of relative humidity and temperature in the upper airways. STUDY DESIGN: Intranasal relative humidity and temperature of 23 volunteers was measured during respiration at different locations in the nasal cavity. METHODS: The end-inspiratory temperature and humidity data, obtained with a miniaturized thermocouple and a capacitive humidity sensor, were determined. RESULTS: A high increase of humidity and temperature at the end of inspiration, in relation to the environmental conditions, was found in the anterior nasal segment. The further increase of both parameters between turbinate area and nasopharynx was less pronounced in spite of the longer distance. CONCLUSIONS: The anterior part of the nasal cavity contributes within a short nasal passage to air conditioning of inspired air.

[Temperature and humidity profile of the paranasal sinuses before and after mucosal decongestion by xylometazolin]. / Temperatur- und Feuchteprofil der Nasenwege vor und nach Schleimhautabschwellung durch Xylometazolin.

BACKGROUND: One of the most important functions of the nose is to warm and to humidify air before it reaches the lower respiratory tract. Nasal decongestants as one of the most common drugs used in otorhinolaryngology are often associated with the feeling of a "dry nose". The purpose of this study was to determine the short-term influence of xylometazoline on temperature and humidity in the nasal airways. METHODS: 15 healthy volunteers were enclosed into the study. A miniaturised humidity sensor and thermocouple was used for detection of humidity and airway temperature in the nasal vestibule, at the nasal valve area and in the nasopharynx at the end of inspiration. Measurements were done before and after topical application of xylometazoline. RESULTS: Temperature and relative humidity increase from the anterior parts of the nose to the nasopharynx at the end of inspiration. The temperature and humidity values after nasal decongestion are not significantly different from the values before application of xylometazoline. As a tendency temperature and humidity values after nasal decongestion are even somewhat higher at the nasal valve area compared to the values before application of xylometazoline. CONCLUSIONS: Widening of the nasal airways by mucosal decongestion did not lead to a significant change of the nasal temperature and humidity profile 20-30 min after application of xylometazoline. The use of xylometazoline seems not to influence humidifying and heating of inspired air within a short period after onset of the maximal decongestive effect of xylometazoline.

Sexual differentiation of estrogen receptor concentrations in the rat brain: effects of neonatal testosterone exposure.

This study tests the hypothesis that sex differences in estrogen receptor (ER) expression in the rat hypothalamus and preoptic area may at least partly result from androgen exposure during the immediate postnatal period. Male rats were castrated and female rats were injected with androgen, at either 15-30 min, 24 h or 10 days after birth. ER distribution in the brain was evaluated by in vitro autoradiography at 28 days of age. Males castrated immediately after birth exhibited higher ER levels in the preoptic area and the ventromedial and arcuate nuclei of the hypothalamus than either control males or males castrated on day 10. Females injected at birth with testosterone propionate exhibited reduced ER binding in the same brain regions. These data suggest that postnatal androgen secretion prior to postnatal day 10 permanently alters patterns of ER expression in the brain.

Sex differences in the development of estrogen receptors in the rat brain.

The mechanisms involved in sexual differentiation of the brain remain incompletely defined. In mammals, testosterone secretion by the male during early development permanently alters the capacity of the brain to respond to circulating estrogen. In rats, this change in estrogen responsiveness is associated with a reduction in estrogen receptor (ER) levels in the periventricular region of the preoptic area (PVP), the medial preoptic nucleus (MPO), and the hypothalamic ventromedial nucleus (VMN) of the male. To determine whether these differences represent a response to early testosterone exposure or a secondary consequence of gonadal secretions at puberty, ER levels were measured by quantitative in vitro autoradiography in the brains of rats killed at intervals between 1-10 and 28-49 days of age. As early as 24 hr after birth, ER sex differences in the MPO and PVP are already quantitatively similar to those observed in adulthood. A sex difference in the VMN emerges later, between 5 and 10 days of age. Differences between brain regions are also observed in the rate of ER development after the first week of life, ER concentrations in the PVP and MPO being close to adult levels within 1 day of birth, in contrast to the VMN where they increase markedly between Day 10 and adulthood in both sexes. These observations suggest that changes in ER concentrations may be one of the earliest hallmarks of brain sexual differentiation. Sex differences in ER in different brain regions may, however, be expressed asynchronously, providing a possible mechanism for variation in the duration of "critical periods" for testosterone-mediated organization of specific CNS functions.

Mnemonic deficits in the double Y-maze are related to the effects of nucleus basalis injections of ibotenic and quisqualic acid on choline acetyltransferase in the rat amygdala.

Many researchers have reported that the magnitude of decrease in cortical choline acetyltransferase (ChAT) following excitotoxic lesions of the nucleus basalis magnocellularis (nbm) is unrelated to the degree of cognitive impairment. Recently, an explanation has been offered for this lack of correlation: different excitotoxins, when injected into the nbm, differentially affected cholinergic projections to the cortex and amygdala, and those excitotoxins previously reported to produce the greatest mnemonic deficits produced the largest decreases in amygdaloid ChAT. The present study evaluated the role of amygdalofugal cholinergic projections in memory by comparing the effects of intra-nbm ibotenic and quisqualic acid on cortical and amygdaloid ChAT and on mnemonic performance in the double Y-maze. Rats were trained in the double Y-maze until working and reference memory choice accuracy stabilized to a criterion of > or = 78% correct. Rats then were given either bilateral quisqualic acid (60 nmol in 0.5 microliter), bilateral ibotenic acid (50 nmol in 0.5 microliter), or sham (0.9% saline in 0.5 microliter) lesions of the nbm, and again were tested on the maze. Quisqualate produced a selective impairment of working memory, a large (51%) decrease in cortical ChAT and a small (17%) decrease in amygdaloid ChAT; ibotenate, on the other hand, produced a greater impairment of working memory, an impairment of reference memory, a similar (51%) decrease in cortical ChAT, but a greater (30%) decrease in amygdaloid ChAT. These results suggest that the cholinergic projections from the nbm to the cortex and amygdala play an important role in memory. They suggest that excitotoxins producing greater depletions of amygdaloid ChAT produce greater mnemonic deficits.

[Damage assessment of a stainless steel lock pin]. / Schadensanalyse eines Verriegelungsnagels aus hochlegiertem Stahl.

Metallurgical investigation methods were used to determine the cause of failure in a broken and explanted lock pin. Material analysis revealed that the implant material consists of a stainless steel. The fractographic investigation indicated a fatigue fracture with its typical characteristics. Macroscopic damage of the outer surface of the implant caused the fatigue fracture in the bone fracture region. Once the lock pin had failed, further crack propagation of the fatigue fracture was largely dependent on stress intensity and/or overloading of the implant in the bone fracture region as well as on the number of stress cycles. The following items should be observed by the physician applying implant materials: 1. A material showing only very small surface scratches in the order of magnitude of thousands of millimeters should not be implanted at all, because even the smallest surface roughness may cause fractures of the material. 2. Implant materials from low-cost manufacturers should never be applied. Such materials often show construction faults (in the present case an unnecessary weld in the upper part of the lock pin) or the material itself is not well conditioned (in the present case an insufficient annealing treatment).

Neonatal exposure to gonadal hormones affects the development of monoamine systems in rat cortex.

Abstract The effects of neonatal gonadectomy of male, and testosterone propionate treatment of female rat pups on levels of monoamines and metabolites in the cerebral cortex were assessed using high-performance liquid chromatography with electrochemical detection. In Experiment 1, pups were killed at 0, 4, 10 and 21 days of age and the anterior and posterior portions of cortex in each hemisphere were removed. At 21 days of age the levels of dopamine in anterior cortex were higher in males and testosterone propionate-treated females than in females and gonadectomized males. However, dopaminergic activity developed earlier in females than in males and the gonadal hormone manipulations shifted the pattern of development to that of the other sex. In Experiment 2, the effects of these same gonadal hormone manipulations on the uptake, metabolism and storage capacity of catecholamine neurons in the cingulate, agranular insular, parietal and occipital cortex were estimated at 4 and 10 days of age by considering the difference between measured catecholamines in animals pretreated with vehicle or 2.5 mg/kg reserpine and then given 100 mg/kg L-DOPA. Again, the data indicated earlier development of catecholamine neurons in females, especially in the agranular insular cortex. Dopamine was found to account for group differences; for when dopamine levels alone were considered it was found that, at 4 days of age, females had the highest levels in every area with the exception of the occipital cortex where gonadectomized males had equally high levels. These data suggest a mechanism that might account for sex differences in the development of specific cortical regions.