Use of a navigation system in endonasal surgery: Impact on surgical strategy and surgeon satisfaction. A prospective multicenter study.

OBJECTIVES: Surgical navigation systems (SNS) are now widely used in endoscopic endonasal surgery. Benefit, however, has not been fully studied. The objective of this study was to evaluate the impact of an SNS in terms of performance of the surgical procedure and of surgeon satisfaction, in a prospective multicenter study. MATERIALS AND METHODS: A multicenter prospective study included patients undergoing endoscopic endonasal surgery using the electromagnetic DigiPointeur® (DGP) SNS in 16 French hospitals. An observation form, completed by the surgeon immediately at end of procedure, included type of procedure, and any changes in strategy or extent of surgery related to use of the SNS. Surgeon satisfaction was rated on an analog scale, with self-assessment of stress experienced during the procedure. RESULTS: The study included 311 patients operated on by 36 surgeons in 16 French hospitals. Ethmoidectomy was the most frequent procedure (90%); tumor resection was performed in 5.1% of cases. The SNS enabled more extensive surgery in 81% of cases, in particular by identifying and opening additional cells (57% of cases). Mean satisfaction was 8.6/10; surgeons reported decreased surgical stress thanks to the SNS in 95% of cases. CONCLUSION: In this observational study, the use of an SNS increased the extent of surgery in 81% of cases, and had a positive impact on the stress perceived by the surgeon in 95% of cases.

Occupational rhinitis and asthma to latex.

Occupational allergic rhinitis to proteins is increasing in importance. Two cases of latex-induced rhinitis are reported in a nurse's aid and a laboratory technician. A crossed food allergy is quoted. Positive prick-tests and specific IgE to latex have been demonstrated in both cases. A double-blind nasal challenge test has been performed with the rinse fluid from a brand of latex gloves. Clinical manifestations with endoscopic modifications of the nasal mucosa have been observed. A rise in nasal secretory eosinophilia has been demonstrated. The authors wish to draw attention to this new aetiology of occupational rhinitis insofar as it precedes the onset of work-related asthma as shown in one case. The eviction of wearing gloves is not sufficient as latex allergens are airborne. The eviction of ordinary latex gloves must be extended to all other workers in the same place and the use of powder-free gloves is advisable.

[Occupational allergic rhinitis]. / Les rhinites allergiques professionnelles.

The frequency of occupational allergic rhinitis has grown with the development of new allergens and the prodromic characteristic of occupational asthma. The clinician must carefully assess the often unimpressive symptomatology with a characteristic work/non work cycle. The nasal mucosa is examined rhinoscopically to eliminate a possible tumoural origin. The diagnosis is based on the results of the allergy tests (skin tests, laboratory tests, nasal allergen tests) and on knowledge of the patient's work environment. The diagnosis of occupational rhinitis requires eliminating the allergen(s). A report of an occupational disease is required. In the future, informing atopic subjects early, improving working conditions and modifying industrial techniques should lead to a reduction in the prevalence of allergic rhinitis and occupational pulmonary disease.

[Study of cells harvested in nasal secretions after lavage. Improvement of the cytologic technique and application to ORL and bronchial pathology]. / Etude des cellules recueillies dans les secrétions nasales apres lavage. Mise au point de la technique cytologique et application aux pathologies orl et bronchiques.

The study of the cells found in the nasal lavage fluid is now a very used method. It has many advantages and it is better than the study of nasal smears obtained by nose blowing and/or swabbing. In this work, we have studied the nasal cytology of patients with a nasal or bronchial pathology. A count of inflammatory cells in a hemocytometer is performed in 301 noses then the percentage of various cell types (eosinophils, lymphocytes and neutrophils) is performed on a glass slide stained by May Grunwald Giemsa. The results are correlated with the literature. The patients with a known NARES have a mean nasal eosinophilia of 26.8%; in the allergic rhinitis, the eosinophilia is 41.4%; the patients with a Fernand Widal Syndrome or with a nasosinusal polyposis have respectively a eosinophil percentage of 24.2% and 18.8%.