Endoscopic inferior turbinate reduction: an outcomes analysis.

OBJECTIVES/HYPOTHESIS: In a previous publication, we introduced an endoscopic technique for the treatment of nasal obstruction caused by inferior turbinate hypertrophy. The technique, a modification of the procedure popularized by Mabry, involves resecting the inferior and lateral aspects of the inferior turbinate with a microdebrider under endoscopic guidance. Our preliminary postoperative results were favorable. All 20 patients experienced improvement by postoperative day 5 and the incidence of complications over the first 6 months after surgery was low. The objective of this study is to perform a long-term outcomes analysis of patients undergoing the procedure. STUDY DESIGN: Follow-up survey questionnaire and analysis. METHODS: We sent questionnaires to 60 patients, ranging from 6 to 40 months after surgery, inquiring about continued use of nasal medications, need for further surgery, presence of adverse effects, and improvement in symptoms. Nasal airway obstruction was assessed on a subjective scoring scale from 1 (no obstruction) to 6 (complete obstruction). RESULTS: Of the 28 (47%) patients who returned questionnaires, the severity of daytime nasal obstruction was rated as 2.3 and nighttime nasal obstruction as 2.7. The use of nasal steroids and oral decongestants was 25% and 21%, respectively. Adverse effects were minimal and all but one patient (96%) experienced improvement in their nasal airway. CONCLUSION: These results confirm the long-term effectiveness of this procedure for the relief of nasal obstruction.

Structure, dynamics, and topological orientation of the polyether, ionophore antibiotic monensin, in a micellar environment.

The structure and dynamics of the ionophoric antibiotic monensin in the presence of micelles have been determined. The conformation of monensin was derived from 50 nuclear Overhauser enhancement (NOE) derived distance restraints and metric-matrix based distance geometry calculations. The conformation was further refined with extensive NOE restrained molecular dynamics simulations carried out in a biphasic simulation cell. From the addition of doxylstearate and monitoring of the induced relaxation of the nmr signals, the relative topological orientation of the molecule within the micelle was ascertained. The results indicate two dihedral angles that act as hinge regions allowing the molecule to adopt a wide range of conformations. Considering the biological activity of monensin, i.e., the capture and transport of cations across cell membranes, an open and closed form of monensin have been postulated. The identification of these hinge regions, which are only observed in the membrane-like environment of the detergent micelles, provides insight into the mechanism of action and can serve as targets for modification to alter the biological profile of monensin.