An Overview of Rhinoplasty Practices: European Academy of Facial Plastic Surgery, Collaborative Cross-Sectional Study.

This collaborative European Academy of Plastic Surgery (EAFPS) study aimed to provide an overview of rhinoplasty practices, informing clinician and patient decision making. It is a multicenter cross-sectional study, reported as per Strengthening the Reporting of Observational Studies in Epidemiology guidelines. All EAFPS members were contacted via email, inviting them to participate. Members expressing an interest to participate were asked to anonymously complete a questionnaire, related to rhinoplasties that they performed as first/supervising surgeon over a period from January 1, 2019 to January 1, 2022. A descriptive analysis was performed. One hundred and fifteen surgeons submitted data on 41,259 rhinoplasties from 33 countries. Eighty percent of rhinoplasties were primary, and 20% were secondary. Thirty five percent of primary rhinoplasties were closed and 65% were open. Thirty one percent of primary rhinoplasties were for cosmetic indications, 11% functional and 58% were for both. Of the 8147 secondary rhinoplasties, 44% were closed and 56% were open. Thirty percent were for cosmetic indications, 11% functional, and 59% for both cosmetic and functional. Ninety-one percent of rhinoplasties were performed by ENT surgeons, 3% by plastic surgeons, 5% by maxillofacial surgeons, and 1% were dual (maxillofacial and ENT) trained. One-thousand seven-hundred thirty primary rhinoplasties underwent revision surgery (5%) and 102 secondary rhinoplasties underwent revision surgery (1%). The most commonly reported indications for revision surgery were dorsal asymmetry, nasal blockage, and dissatisfaction with nasal tip. Three percent of rhinoplasties underwent preoperative psychological assessment. To the authors knowledge, this is the largest published rhinoplasty dataset. This study provides an overview of rhinoplasty practices that can be used for benchmarking and to guide clinician and patient decision making. Psychological assessment of prerhinoplasty appears insufficient with higher levels recommended to minimize unsuccessful outcomes. This study showcases the power of collaborative research and may serve as a catalyst for future collaborative facial plastic surgery research.

Photosynthetic pigments and quantum yield of West Indian cherry under salt stress and NPK combinations.

West Indian cherry cultivation has proved to be an important economic activity in northeastern Brazil. However, irrigation with brackish waters limits cultivation, requiring new strategies to minimize the effect of salt stress. In this context, the present study aimed to evaluate the effect of nitrogen (N), phosphorus (P), and potassium (K) combinations on the photosynthetic pigments and quantum yield of West Indian cherry cultivated under salt stress, in the second year of production. The assay was conducted in a protected environment by adopting an experimental design in randomized blocks, with treatments distributed in a 2×10 factorial arrangement referring to two electrical conductivity levels of irrigation water - ECw (0.6 and 4.0 dS m-1) and 10 NPK fertilization combinations - FC (80-100-100; 100-100-100; 120-100-100; 140-100-100; 100-80-100; 100-120-100; 100-140-100; 100-100-80; 100-100-120, and 100-100-140% of the recommendation, in the second year of production), with three replications, each consisting of one plant. Irrigation with the electrical conductivity of 4.0 dS m-1 negatively affected the synthesis of photosynthetic pigments and the photochemical efficiency of the West Indian cherry cv. Flor Branca. The NPK combinations did not attenuate the effects of salt stress on the analyzed variables. However, the combinations referring to 120-100-100%, 140-100-100%, and 100-120-100% of NPK recommendation improved the quantum yield of photosystem II by reducing the initial fluorescence and increasing the maximum fluorescence of the West Indian cherry cv. Flor Branca.

Morphophysiology and production of bell pepper grown under salt stress and salicylic acid foliar application.

Considering the relevance of bell pepper and the limitations imposed by the deleterious effects of salt stress, especially in semi-arid regions, it is extremely important to establish strategies that can facilitate the use of saline water in vegetable production. In this scenario, this study aimed to evaluate the effect of the frequency of foliar application of salicylic acid on the morphophysiology and production of the bell pepper cv. "All Big" irrigated with saline water. The study was conducted at a greenhouse in Campina Grande - PB. The treatments were distributed in a completely randomized design and set up in a 4 × 4 factorial arrangement with three replications, corresponding to four application frequencies of salicylic acid (F1- No application of salicylic acid, F2 - Weekly application, F3- fortnightly application, and F4- monthly application) and four levels of electrical conductivity of irrigation water - ECw (0.8, 1.6, 2.4 and 3.2 dS m-1). The fortnightly application of salicylic acid at a concentration of 1.0 mM mitigated the effects of salt stress on the morphophysiology and production components of bell pepper cv. All Big cultivated with ECw of up to 2.4 dS m-1, which reinforces the hypothesis that salicylic acid can act as a signaling molecule and reduce the effects of saline stress in bell pepper, enabling the use of brackish water in agricultural activity, mainly in semi-arid regions of northeastern Brazil, which have a shortage of fresh water.

Hydrogen peroxide in attenuation of salt stress effects on physiological indicators and growth of soursop.

To mitigate the deleterious effects of salt stress, substances capable of acting as mitigators and/or inducers of tolerance to stress have been used, enabling the use of saline waters and contributing to the development of irrigated agriculture. In this context, the aim of the present study was to evaluate the effect of foliar spraying with hydrogen peroxide as an attenuator of salt stress effects on soursop morphophysiology. The experiment was conducted under greenhouse conditions in Campina Grande - PB, Brazil, using a randomized block design, in a 4 × 4 factorial arrangement, whose treatments resulted from the combination of four levels of electrical conductivity of irrigation water - ECw (0.8 - control, 1.6, 2.4, and 3.2 dS m-1) and four concentrations of hydrogen peroxide - H2O2 (0, 10, 20, and 30 µM), with three replicates. Foliar application of hydrogen peroxide at a concentration of 10 µM increased growth, chlorophyll synthesis, and relative water content in the leaves and consequently reduced the foliar water saturation deficit of soursop irrigated with ECw up to 1.6 dS m-1. The concentration of hydrogen peroxide of 30 µM intensified the salt stress on the electrolyte leakage in the leaf blade and the photosynthetic pigments of soursop, 270 days after transplanting.

A classical model of educational cooperation in Human Anatomy: the Table Leaders.

This project has been developed for many years in the Human Anatomy courses.Its good outcomes have been confirmed by years of evidence of excellent resultsobtained through the learning of Human Anatomy. This method of teaching andlearning as one allows students who are taking Human Anatomy classes to receivepractical training in small groups and transmit it to their colleagues in the practicaltraining established in the Medical degree. Table Leaders feel rewarded as theylearn to speak in public, regularly transmitting the knowledge obtained, and byhaving to be up to date with their studies. These are all aspects that help, not onlythe Table Leaders process of learning, but also that of their colleagues, who seeclosely and carefully anatomical details that help them understand the subject.This method of supporting practical training is always under the supervision ofthe teacher who develops the practical classes. These Leaders used to pass thetest without additional problems. Thus the note was significantly increased versusthe class colleagues.

Exigências de energia de borregas mestiças alimentadas com níveis crescentes de concentrado na dieta / Energy requirements of crossbreed ewe lambs fed with increasing dietary levels of concentrate

Objetivou-se estimar as exigências energéticas de borregas mestiças confinadas, alimentadas com níveis crescentes de concentrado na dieta. Foram avaliadas 36 borregas, com peso corporal inicial de 23,7±3,67kg. Seis animais foram abatidos no início do experimento para obtenção dos valores do grupo referência. Os demais (30 animais) foram distribuídos em cinco tratamentos: mantença (alimentação restrita com feno de capim Tifton) e suplementados com níveis crescentes de concentrado (20, 40, 60 e 80%) em base de matéria seca (seis animais por tratamento). As borregas foram abatidas quando atingiram 37,70±9,89kg. Os níveis de concentrado influenciaram a eficiência de utilização da energia metabolizável para mantença (km) e consequentemente as exigências diárias de energia metabolizável para mantença. A exigência de energia líquida para mantença de borregas mestiças em crescimento é 57 kcal/PCJ0,75/dia, em que PCJ é o peso corporal em jejum. As borregas com 20kg apresentaram exigência de energia líquida para 100g de ganho de peso diário de 465kcal/dia. As borregas com 40kg de peso corporal exigiram 930kcal/dia de energia líquida para o mesmo ganho. A exigência líquida para mantença de borregas pode ser estimada pela equação: ELm (Mcal/dia) = 0,057* PCJ0,75. A exigência líquida de energia para ganho de borregas mestiças (Mcal/dia) pode ser estimada a partir da equação: ELg = 0,524 x PVJ0,75 x GPCVZ1,21, em que GPCVZ é o ganho de peso do corpo vazio. As dietas influenciam as eficiências de usos da energia metabolizável para mantença (km) e ganho (kg).(AU)

The aim of this study was to estimate the energy requirements of crossbreed ewe lambs in a feedlot fed with increasing levels of concentrate in the diet. 36 ewe lambs were evaluated with initial body weight of 23.7±3.67kg. Six animals were slaughtered at the beginning of the experiment to obtain the reference group values. Animals (30) were distributed in five treatments: maintenance (feed restricted with Tifton grass hay) and those supplemented with increasing dietary levels of concentrate (20, 40, 60 and 80%) on a dry matter basis (six animals per treatment). The ewe lambs were slaughtered when they reached 37.70±9.89kg. The concentrate levels influenced the utilization efficiency of metabolizable energy for maintenance (km) and consequently the daily requirements of metabolizable energy for maintenance. The net energy requirements for maintenance of crossbred lambs in growth is 57kcal/FCW 0.75/day, where FCW is body weight on fasting. The ewe lambs with 20kg presented net energy requirement for 100g daily weight gain of 465kcal/day. The ewe lambs with 40kg of body weight required 930 kcal/day of net energy for the same gain. The net energy requirement for maintenance of ewe lambs can be estimated by the equation: NEm (Mcal/day) = 0.057 * FCW0.75. The net energy requirement for crossbred ewe lambs gain (Mcal/day) can be estimated from the equation: NEg (Mcal/day) = 0.524*FCW 0.75*GEBW1.21, where GEBW represented gain empty body weight. Diets affect the efficiencies of uses of metabolizable energy for maintenance (km) and gain (kg).(AU)

Feed efficiency indexes and their relationships with carcass, non-carcass and meat quality traits in Nellore steers.

Five hundred and seventy-five Nellore steers were evaluated for residual feed intake and residual feed intake and gain and their relationships between carcass, non-carcass and meat quality traits. RFI was measured by the difference between observed and predicted dry matter intake and RIG was obtained by the sum of -1*RFI and residual gain. Efficient and inefficient animals were classified adopting ±0.5 standard deviations from RFI and RIG mean. A mixed model was used including RFI or RIG and contemporary group as fixed effects, initial age as covariate and sire and experimental period as random effects, testing the significance of the regression slope for each evaluated trait. RIG was positively related to longissimus muscle area. Efficient-RFI animals had lower liver and internal fat proportions compared to inefficient-RFI animals. Efficient-RFI and efficient-RIG animals had 11.8% and 11.2% lower extracted intramuscular fat, compared to inefficient-RFI and inefficient-RIG animals, respectively. Efficient-RFI animals had tougher meat compared to inefficient-RFI animals.

Associação de palma forrageira com feno de maniçoba ou silagem de sorgo e duas proporções de concentrado na dieta de vacas em lactação / The effect of the association of spinelles cactus with maniçoba hay and sorghum silage and two dietary concentrate in lactating dairy

Objetivou-se avaliar a utilização da silagem de sorgo, feno de maniçoba e duas proporções de concentrado (10 e 15% na MS) em dietas à base de palma forrageira na alimentação de vacas em lactação. Foram utilizadas oito vacas da raça Girolando, com peso vivo médio e produção inicial de 463 e 9,65kg, respectivamente, com 95 dias de lactação. O delineamento experimental utilizado foi o quadrado latino 4x4 em esquema fatorial 2x2 (feno de maniçoba e silagem de sorgo x 10% e 15% de concentrado), sendo utilizados dois quadrados simultâneos. Cada período experimental teve duração de 21 dias, sendo 14 de adaptação e sete para coleta de dados e amostras. Não houve interação entre volumosos e proporções de concentrado para nenhuma das variáveis avaliadas. Assim, os fatores foram analisados e discutidos separadamente. Os consumos de proteína bruta, fibra em detergente neutro e nutrientes digestíveis totais diferiram em função dos volumosos utilizados, com menores consumos para o feno de maniçoba (1,50; 4,10; 6,17kg/dia, respectivamente). A digestibilidade aparente da matéria seca, matéria orgânica, proteína bruta e fibra em detergente neutro diferiram de acordo com os volumosos, verificando menores valores para o feno de maniçoba (51,70; 53,91; 62,30 e 20,74%, respectivamente). A produção de leite com ou sem correção para 4% de gordura (9,65 e 9,1kg/dia, respectivamente) e composição do leite não diferiram entre os volumosos, nem entre os níveis de concentrados. A eficiência de síntese de proteína microbiana diferiu entre os volumosos, sendo menor no tratamento com silagem de sorgo (99,46g/kg de NDT). A concentração de ureia no plasma diferiu entre as proporções de concentrado, com menores valores na dieta com 15% de concentrado (31,41mg/dL). Para o atendimento das exigências nutricionais e redução dos custos com suplementação, sugere-se o fornecimento de silagem de sorgo como volumoso e a proporção de 10% de concentrado na dieta de vacas em lactação.

The trial was conducted to evaluate the use of sorghum silage, maniçoba hay, and two concentrate levels (10.0% and 15.0% DM) in diets based on spineless cactus of dairy cows. Eight Girolando cows were used with average body weight and milk yield of 463 and 9.65kg, respectively, with 95 days of lactation. The experimental design was a 4 x 4 Latin Square in a 2 x 2 factorial arrangement (maniçoba hay and sorghum silage x 10.0% and 15.0% of concentrate), two simultaneous Latin Square were used. Each experimental period lasted 21 days; 14 days for adaptation and seven for data and sample collection. There was no interaction between roughage and concentrate level for any of the variables. Thereby the factors were analyzed and discussed separately. The intake of crude protein, neutral detergent fiber and total digestible nutrients differ according to roughage used with lower intake for maniçoba hay (1.50; 4.10; 6.17kg/day, respectively). The apparent digestibility of dry matter, organic matter, crude protein and neutral detergent fiber differed according to the roughage, and lower values were found for maniçoba hay (51.70; 53.91 and 20.74%, respectively). The milk yield with and without adjustment to 4.0% of fat (9.65 and 9.1kg/day, respectively) and the milk composition did not differ between roughages or between concentrate levels. The efficiency of microbial protein synthesis differs between roughages and was lower in the treatment with sorghum (99.46g/kg TDN). The concentration of plasma urea differed between the ratios of concentrate with lower amounts in the diet with 15.0% concentrate (1.41mg/dL). To meet the nutritional requirements and cost reduction with supplementation a supply with sorghum silage as roughage and 100% of concentrate for diet of lactation cows is suggested.

Spontaneous subcutaneous emphysema associated with mephedrone usage.

Subcutaneous emphysema in the head and neck is a rare condition, normally caused by major underlying injury to the airway or gastrointestinal tract. We report a non-traumatic occurrence of spontaneous cervical subcutaneous emphysema in a 30-year-old man who had been snorting mephedrone. The patient made an uneventful recovery, being managed conservatively, and did not require airway support. The occurrence of spontaneous cervical emphysema associated with snorting mephedrone has not been previously described in the literature.

Hymenopteran parasitoids associated with frugivorous larvae in a Brazilian caatinga-cerrado ecotone.

The purpose of this study was to investigate native species of parasitoids of frugivorous larvae and their associations with host plants in commercial guava orchards and in typical native dry forests of a caatinga-cerrado ecotone in the State of Minas Gerais, Brazil. Nine species of parasitoids were associated with larvae of Anastrepha (Tephritidae) and Neosilba (Lonchaeidae) in fruit of Psidium guajava L. (Myrtaceae), Ziziphus joazeiro Mart. (Rhamnaceae), Spondias tuberosa Arruda (Anacardiaceae), Spondias dulcis Forst. (Anacardiaceae), Syzygium cumini (L.) Skeels (Myrtaceae), and Randia armata (Sw.) DC. (Rubiaceae). Doryctobracon areolatus was the most abundant species, obtained from puparia of Anastrepha zenildae, An. sororcula, An. fraterculus, An. obliqua, and An. turpiniae. This is the first report of Asobara obliqua in Brazil and of As. anastrephae and Tropideucoila weldi in dry forests of Minas Gerais State. The number of species of parasitoids was higher in areas with greater diversity of cultivated species and lower pesticide use. The forest fragments adjacent to the orchards served as shelter for parasitoids of frugivorous larvae.

Sampling methods for assessing social wasps species diversity in a eucalyptus plantation.

Social wasps were collected in a eucalyptus (Eucalyptus urograndis, a genetically enhanced eucalyptus) plantation in Juiz de Fora, state of Minas Gerais, southwestern of Brazil, by using a variety of sampling methods, including active capture and baited traps set at two microhabitats. Six new records of social wasps for this region were obtained during the study: Brachygastra lecheguana Latreille, Polybia ignobilis Haliday, Polybia occidentalis Olivier, Polybia platycephala (Richards), Protonectarina sylveirae Saussure, and Protopolybia exigua Saussure (Hymenoptera: Vespidae). The active capture method sampled the greatest number of species. Baited traps installed in the canopy sampled agreater number of individuals of social wasps than those set on the trunks of eucalyptus trees. Fruit based baits captured a greater number of social wasp species than those baited with a protein derivative. Once no method was able to sample all species, we concluded that the efficiency of a survey can be maximized by using traps with a variety of different baits, in combination with active capture methods.

Consumo e digestibilidade de nutrientes de dietas com silagens de grãos úmidos de milho ou sorgo, em ovinos / Intake and digestibility of nutrients in sheep diets based on corn and sorghum grain high moisture silages

Avaliaram-se o consumo, a digestibilidade e o teor de nutrientes digestíveis totais (NDT) de dietas contendo silagens de grãos úmidos de milho e de sorgo, com ou sem inoculante microbiano, em ovinos. O volumoso utilizado foi feno de capim-braquiária (Brachiaria brizantha cv. Marandu). Doze animais foram distribuídos em quatro tratamentos: (1) feno+silagem de grão úmido de milho, (2) feno+silagem de grão úmido de sorgo; (3) feno+silagem de grão úmido de milho com inoculante microbiano e (4) feno+silagem de grão úmido de sorgo com inoculante microbiano. Não houve diferença entre tratamentos quanto aos consumos de matéria seca, de matéria orgânica, de proteína bruta, de fibra em detergente neutro, de carboidratos totais e de carboidratos não estruturais. O consumo de extrato etéreo diferiu em função do tipo de grão. Não houve diferença entre tratamentos quanto à digestibilidade dos nutrientes. Não houve efeito do grão e da inoculação para o NDT estimado das silagens de grãos úmidos de milho e de sorgo, com médias de 77,6 por cento e 79,5 por cento, respectivamente. O uso de inoculante microbiano em silagens de grãos úmidos não se fez necessário. O grão de milho úmido pode ser substituído pelo de sorgo sem prejuízos ao aproveitamento de nutrientes em ovinos adultos.

The intake, the digestibility of nutrients, and the total digestible nutrients (TDN) content in sheep diets based on corn and sorghum grains high moisture silages with or without microbial inoculant, were evaluated. The used roughage was Brachiaria hay (Brachiaria brizantha cv. Marandu). Twelve animals were distribuited to treatments: (1) hay+high moisture corn grain silage, (2) hay+high moisture sorghum grain silage; (3) hay+high moisture corn grain silage with microbial inoculant, and (4) hay+high moisture sorghum grain silage with microbial inoculant. No differences among treatments in relation to the intake of dry matter, organic matter, crude protein, neutral detergent fiber, and total and non-structural carbohydrates were observed. The ether extract intake differed according to the grains. The silages did not differ in relation to the estimated digestibilities for dry matter, organic matter, crude protein, neutral detergent fiber, ether extract, and total and non-structural carbohydrates. The TDN did not differ according to the grains and inoculant, with averages of 77.6 and 79.5 percent, for corn and sorghum grains high moisture silages, respectively. It was demonstrated that the use of microbial inoculant, in high moisture grain silages was not necessary. High moisture corn grain silage can be substituted by high moisture sorghum grain silage without effects on the use of nutrients by sheep.

There is no difference in hepatic fibrosis rates of patients infected with hepatitis C virus and those co-infected with HIV

Some studies have suggested that human immunodeficiency virus (HIV) infection modifies the natural history of hepatitis C virus (HCV) infection, accelerating the progression of fibrosis and the development of cirrhosis. Our objective was to evaluate the fibrosis progression rate (FPR) in HCV/HIV-co-infected patients, and to identify factors that may influence it. HCV-mono-infected and HCV/HIV-co-infected patients with a known date of HCV infection (transfusion or injection drug use) and a liver biopsy were included. The FPR was defined as the ratio between the fibrosis stage (Metavir score) and the estimated length of infection in years and the result was reported as fibrosis units per year. The factors studied were gender, age at infection, consumption of alcohol, aminotransferase levels, histological activity grade, HCV genotype and viral load, CD4 cell count, HIV viral load, and the use of antiretroviral therapy. Sixty-five HCV-infected (group 1) and 53 HCV/HIV-co-infected (group 2) patients were evaluated over a period of 19 months. The mean FPR of groups 1 and 2 was 0.086 ± 0.074 and 0.109 ± 0.098 fibrosis units per year, respectively (P = 0.276). There was a correlation between length of HCV infection and stage of fibrosis in both groups. The age at infection, the aspartate aminotransferase level (r = 0.36) and the inflammatory activity grade were correlated with the FPR (P < 0.001). No difference in FPR was found between HCV-mono-infected and HCV/HIV-co-infected patients.

There is no difference in hepatic fibrosis rates of patients infected with hepatitis C virus and those co-infected with HIV.

Some studies have suggested that human immunodeficiency virus (HIV) infection modifies the natural history of hepatitis C virus (HCV) infection, accelerating the progression of fibrosis and the development of cirrhosis. Our objective was to evaluate the fibrosis progression rate (FPR) in HCV/HIV-co-infected patients, and to identify factors that may influence it. HCV-mono-infected and HCV/HIV-co-infected patients with a known date of HCV infection (transfusion or injection drug use) and a liver biopsy were included. The FPR was defined as the ratio between the fibrosis stage (Metavir score) and the estimated length of infection in years and the result was reported as fibrosis units per year. The factors studied were gender, age at infection, consumption of alcohol, aminotransferase levels, histological activity grade, HCV genotype and viral load, CD4 cell count, HIV viral load, and the use of antiretroviral therapy. Sixty-five HCV-infected (group 1) and 53 HCV/HIV-co-infected (group 2) patients were evaluated over a period of 19 months. The mean FPR of groups 1 and 2 was 0.086 +/- 0.074 and 0.109 +/- 0.098 fibrosis units per year, respectively (P = 0.276). There was a correlation between length of HCV infection and stage of fibrosis in both groups. The age at infection, the aspartate aminotransferase level (r = 0.36) and the inflammatory activity grade were correlated with the FPR (P < 0.001). No difference in FPR was found between HCV-mono-infected and HCV/HIV-co-infected patients.

Sub-alar batten grafts as treatment for nasal valve incompetence; description of technique and functional evaluation.

OBJECTIVE: To describe and evaluate the functional results of a surgical technique for treating nasal valve incompetence, in which a cartilage graft called a sub-alar batten graft is placed along the undersurface of the lateral crus of the lower lateral cartilage. METHODS: The functional outcomes of 27 patients who had sub-alar batten grafts placed on 39 sides were evaluated by means of clinical examination and subjective self-assessment. RESULTS: Of a total of 39 sides operated upon, 10 (26%) were rated as optimal, 15 (39%) as improved, 13 (33%) as equal and 1 (2%) as worse. Overall on 25 sides (65%) the post-operative situation was considered to be better than pre-operatively. In all cases in which there was a wish for cosmetic improvement, besides the functional indication, this was obtained, and in no case did the grafts give cause to cosmetic grievances or other complications. CONCLUSION: Placement of sub-alar battens had a positive effect on nasal valve function in roughly two thirds of cases in this series. Although in our opinion this result was slightly disappointing from a purely functional point of view, they can improve the cosmetic result and continue to be considered in cases in which avoidance of surface irregularities is a primary concern or as a preventative measure in rhinoplasty patients at risk for post-operative valve collapse.

Immunotherapy for allergic rhinitis--a United Kingdom survey and short review.

Allergic rhinitis (AR) is a common condition which is treated using different modalities, including immunotherapy. The aim of this study was to survey the current management strategies among ENT consultants in the UK in treating AR, and their views on immunotherapy. The study design was a postal questionnaire survey and the setting a university teaching hospital. Participants were consultant members of the British Association of Otolaryngologists - Head and Neck Surgeons (BAO-HNS). The main outcome measures were common treatment modalities adopted by the survey group to treat AR, and the number of consultants practising immunotherapy. The majority (81.1 per cent) of the consultants surveyed practise medical therapy with or without surgery. Immunotherapy is advised by 26 per cent of ENT consultants, but only 6.6 per cent currently administer immunotherapy.

The influence of the Internet on decision making in acoustic neuroma.

OBJECTIVE: To determine the access to and the use of the Internet by acoustic neuroma patients as a medical information source, and the influence of the Internet on decision-making, as well as the patients' views on the quality of particular sites. MATERIALS AND METHODS: A retrospective 27-item questionnaire was sent to 138 consecutive acoustic neuroma patients diagnosed between 1997 and 2002. The study included patients treated by conservative, radiotherapeutic and surgical modalities. MAIN OUTCOME MEASURES: Patient demographics, the extent of Internet use as well as quality and quantity of available information. RESULTS: There were 86.95 per cent questionnaires available for analysis. Twenty-four per cent accessed the Internet to obtain information about acoustic neuromas. Ninety-seven per cent of patients said that the information provided in the clinic matched with the information obtained from the websites, 49 per cent said that the information obtained from the Internet did not influence decision making regarding acceptance of treatment of their tumour. Some patients said the Internet information was depressing, devastating, and they would never look up the Internet again for medical information. CONCLUSION: A significant proportion of our patients accessed the Internet for information. Caution should be exercised when advising patients regarding websites as the information on the Internet is often not controlled or checked for accuracy. Acoustic neuroma specialists and ENT surgeons in general should familiarize themselves with related websites so that patients can then be directed to high-quality sites.

Dissemination of fat in CSF: a common finding following translabyrinthine acoustic neuroma surgery*.

OBJECTIVES: Following translabyrinthine craniotomy the temporal bone defect is commonly obliterated using a free autologous fat graft. In this series the dura was put back in place but not closed primarily. As the fat graft remains in direct contact with the cerebro spinal fluid (CSF) there is potential for dispersal of fat within the CSF space. This paper aims to determine the frequency of such CSF fat dissemination and its clinical significance. DESIGN: A retrospective review of translabyrinthine acoustic neuroma removal with free fat autograft obliteration of the temporal bone defect between the years 1997 and 2000. SETTING: Tertiary referral oto-neurosurgical centre. Postoperative magnetic resonance (MR) imaging. PARTICIPANTS: All translabyrinthine patients who had postoperative MR imaging were included. Twenty-six cases were identified. Age range was 13-70 years. Fourteen were male patients. MAIN OUTCOME MEASURES: Evidence of CSF fat dissemination on MR and patients' clinical findings. RESULTS: Twenty-two of the 26 scans (85%) demonstrated evidence of fat dissemination into the subarachnoid CSF spaces in the form of microemboli. The cerebellopontine angle was the most common site involved. No evidence of ventricular dilation or any other abnormality was noted. There was no relationship between the presence or extent of fat microembolization and the patients' clinical course. CONCLUSIONS: This study suggests that free fat placed in temporal bone defects commonly migrate into the subarachnoid space and subsequently move around in these spaces. This is not associated with any complications such as hydrocephalus, meningitis or prolonged postoperative headache.

Atypical gastric presentation of strongyloidiasis in HIV-infected patient--case report.

Strongyloides stercoralis is an intestinal helminth of systemic distribution, which, once in its host, has the ability to perpetuate itself through an autoinfection cycle, leading to chronic infection. In healthy hosts, the parasite usually does not cause any symptoms, or only mild symptoms that are limited mainly to the small intestine. However, in immunocompromised hosts, uncontrolled multiplication with massive infection may occur, causing hyperinfection syndrome or disseminated strongyloidiasis, which are both associated with high morbidity and mortality. There are few reports of gastric involvement, particularly presenting as ulcer in the stomach. We report a case of gastric ulcer caused by S. stercoralis in HIV-infected patient.

Simple snoring: current practice.

Snoring is a significant problem with both social and medical manifestations. This article addresses the current management of the simple snorer from initial out-patient assessment to definitive treatment.