Cerebrovascular reactivity to l-arginine in the anterior and posterior cerebral circulation in migraine patients.

OBJECTIVE - Cerebral infarction preferentially affects the posterior cerebral artery distribution in migraine patients. The results obtained from the few known studies that have compared the anterior and posterior cerebral endothelial function are contradictory. To the best of our knowledge, cerebrovascular reactivity to L-arginine (CVR), measured by transcranial Doppler sonography (TCD), has not been previously used to determine the posterior cerebral endothelial function in migraine patients with (MwA) and without aura (MwoA). MATERIALS AND METHODS - Forty migraine patients without comorbidities (20 MwA, 20 MwoA) and 20 healthy subjects were included. By employing strict inclusion criteria, we avoided the possible vascular risk factors. Mean arterial velocity in the middle cerebral artery (MCA) and the posterior cerebral artery (PCA) was measured by TCD before and after infusion of L-arginine, and CVR to L-arginine was then calculated. RESULTS - All migraine patients had lower CVR to L-arginine in PCA (P = 0.002) and similar in MCA (P = 0.29) compared to healthy subjects. This difference was also present in MwA and MwoA compared to healthy subjects (P = 0.003). CONCLUSIONS - Lower CVR to L-arginine in PCA in migraine patients could associate migraine and cerebral infarcts that are more common in the posterior cerebral artery distribution.

Nasoantral windows: an experimental study in rabbits.

An experimental study was designed to compare the effects of enlargement of the maxillary ostium to inferior meatal antrostomy. In 10 rabbits, the sinus ostium was enlarged (osteoplasty group), and in 10 other animals, a window of the same size was created far from the ostium (antrostomy group). The control groups were 7 rabbits in which no surgery was performed and 6 rabbits in which only the surgical approach was performed. At reexploration 14 and 84 days after surgery, it was observed that rabbits in the osteoplasty group had significantly more infections of the sinuses than the antrostomy group and both control groups (P less than .05). Possible reasons for the difference in infection rate are discussed. These data indicate that, in normal maxillary sinuses of rabbits, disruption of the ostium results in an increased incidence of infection.

[Concept and technique for closure of septum defects]. / Konzept und Techniken für den Verschluss von Septumdefekten.

A surgical concept for the closure of perforations of the septum is presented. Small and medium-sized defects are closed by a one-step extramucosal technique also used in rhinoplasties. Tissue tubes of mucoperichondrium, mucoperiosteum and the upper lateral cartilage are mobilized in both nasal lumina. Parts of the lamina quadrangularis are dissected and shifted to close the defect. Very large defects with a diameter of more than 3 cm are closed in a three-step technique. A spoon-shaped flap from the oral vestibule with a piece of ear cartilage attached is inserted into the perforation. The cartilage is covered with oral mucosa on both sides. These procedures are superior to traditional techniques in terms of both blood supply and safe closure.

Temperature measurements in the maxillary sinus of rabbits.

An experimental study was designed to investigate the temperature of the maxillary sinus before and after creation of nasoantral windows and in relation to different ambient temperatures. In 10 rabbits the natural ostium was enlarged (ostioplasty) and in 10 other animals a window was created far from the ostium (antrostomy). Six rabbits, in which no surgery was performed on the nasoantral wall, served as controls. The results show that before surgery, the temperature of the sinus is kept constant even when the external temperature changes. After ostioplasty or antrostomy, the capacity of air conditioning is significantly reduced and the sinus temperature changes in correlation to the environmental temperature.

[Reconstruction of the upper lip using the mucosal eversion technic]. / Rekonstruktion der Oberlippe mit der Mukosa-Eversions-Technik.

A one-stage reconstruction technique for upper lip defects is presented. This technique uses everted mucosal advancement flaps for the reconstruction of the vermilion border of the lip. It is an extension of Meyer's method employed in the reconstruction of the lower lip (1973) and differs from Camille Bernard's procedure in that horizontal incisions with bilateral triangular skin excisions are used instead of the more unaesthetic perpendicular incisions in the nasolabial fold, leaving a scar along the vermilion border. The method is suitable for reconstructing the upper lip after excision of up to 80% of its substance, and is superior to traditional methods in terms of both the functional and aesthetic results obtained.

Endoscopic surgery of the frontal sinus without external approach.

Many surgical techniques have been described for the treatment of recurrent or persistent frontal sinusitis. The major difficulty of all techniques is to avoid recurrent stenosis of the frontonasal duct. Our endoscopic surgical technique without an external approach is described, which allows the creation of a bony and rigid frontonasal duct. Our first results seem to confirm the hypothesis that the creation of such a duct reduces the frequency of secondary stenosis and therefore the recurrencies of frontal sinusitis.