Direct maxillary irrigation therapy in non-operated chronic sinusitis: a prospective randomised controlled trial.

OBJECTIVE: This study aimed to compare the effectiveness of pharmacological therapy with and without direct maxillary sinus saline irrigation for the management of chronic rhinosinusitis without polyps. METHODS: In this prospective randomised controlled trial, 39 non-operated patients were randomly assigned to be treated with direct maxillary sinus saline irrigation in conjunction with systemic antibiotics and topical sprays (n = 24) or with pharmacological therapy alone (n = 15). Endoscopy, Sino-Nasal Outcome Test and Lund-MacKay computed tomography scores were obtained before, six weeks after and one to two years after treatment. RESULTS: Post-treatment Lund-Mackay computed tomography scores were significantly improved in both cohorts, with no inter-cohort difference identified. Post-treatment nasal endoscopy scores were significantly improved in the study group but were similar to those measured in the control group. The Sino-Nasal Outcome Test-20 results showed improvement in both cohorts, with no difference between treatment arms. CONCLUSION: Maxillary sinus puncture and irrigation with saline, combined with pharmacological treatment improves endoscopic findings in patients with chronic rhinosinusitis without polyps, but has no beneficial effect on symptoms and imaging findings over conservative treatment alone.

Chronic infusion of SOD1G93A astrocyte-secreted factors induces spinal motoneuron degeneration and neuromuscular dysfunction in healthy rats.

Amyotrophic lateral sclerosis is a fatal neurodegenerative disease and studies in vitro show that motoneuron degeneration is triggered by non-cell-autonomous mechanisms. However, whether soluble toxic factor(s) released by mutant superoxide dismutase 1 (SOD1) expressing astrocytes induces death of motoneurons and leads to motor dysfunction in vivo is not known. To directly test this, healthy adult rats were treated with conditioned media derived from primary mouse astrocytes (ACM) that express human (h) SOD1G93A (ACM-hG93A) via chronic osmotic pump infusion in the lumbar spinal cord. Controls included ACM derived from transgenic mice expressing hSOD1WT (ACM-hWT) or non-transgenic mouse SOD1WT (ACM-WT) astrocytes. Rats chronically infused with ACM-hG93A started to develop motor dysfunction at 8 days, as measured by rotarod performance. Additionally, immunohistochemical analyses at day 16 revealed reactive astrogliosis and significant loss of motoneurons in the ventral horn of the infused region. Controls did not show significant motor behavior alterations or neuronal damage. Thus, we demonstrate that factors released in vitro from astrocytes derived from ALS mice cause spinal motoneuron death and consequent neuromuscular dysfunction in vivo.

[Ocular prosthetics. Fitting, daily use and complications]. / Augenprothetische Versorgung. Anpassung, Handhabung und Komplikationen.

BACKGROUND: Ocular prosthetics make a decisive contribution to the functional, esthetic and psychosomatic rehabilitation of patients after ocular extirpation. OBJECTIVES: This article provides an overview of the fitting, daily care and complications of ocular prosthetics. METHODS: The study comprised a PubMed literature review and own clinical results. RESULTS: Ocular prosthetics made from cryolite glass or perspex can be manufactured and fitted 5-8 weeks after removal of the eye. During this period a conformer is placed within the conjunctival sac in order to prevent scar formation and shrinking of the socket. Artificial eyes can be worn continuously, only interrupted by a short but regular cleaning procedure. Artificial tears and lid hygiene improve the comfort of wearing. Glass prostheses have to be renewed every 1-2 years, while perspex prostheses need to be polished once a year. Complications, such as giant papillary conjunctivitis or blepharoconjunctivitis sicca are facilitated by poor fit, increased age and inappropriate care of the prosthetic device. In the case of socket shrinkage or anophthalmic socket syndrome, surgical interventions are needed to re-enable the use of an artificial eye. CONCLUSION: Adequate fitting, daily care of ocular prosthetics and therapeutic management of associated complications are mandatory for a durable functional, esthetic and psychosomatic rehabilitation after ocular extirpation.

Histone deacetylases and their role in motor neuron degeneration.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease, characterized by the progressive loss of motor neurons. The cause of this selective neuronal death is unknown, but transcriptional dysregulation is recently emerging as an important factor. The physical substrate for the regulation of the transcriptional process is chromatin, a complex assembly of histones and DNA. Histones are subject to several post-translational modifications, like acetylation, that are a component of the transcriptional regulation process. Histone acetylation and deacetylation is performed by a group of enzymes (histone acetyltransferases (HATs) and deacetylases, respectively) whose modulation can alter the transcriptional state of many regions of the genome, and thus may be an important target in diseases that share this pathogenic process, as is the case for ALS. This review will discuss the present evidence of transcriptional dysregulation in ALS, the role of histone deacetylases (HDACs) in disease pathogenesis, and the novel pharmacologic strategies that are being comprehensively studied to prevent motor neuron death, with focus on sirtuins (SIRT) and their effectors.

Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis: diagnostic criteria.

BACKGROUND: Chronic sinusitis is one of the most common otolaryngological diagnoses. Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis can easily be misdiagnosed and treated as chronic sinusitis, causing continuing harm. AIM: To better identify and characterise these two subgroups of patients, who may suffer from a systemic disease requiring multidisciplinary treatment and prolonged follow up. METHODS: A retrospective, longitudinal study of all patients diagnosed with allergic fungal sinusitis or eosinophilic mucin rhinosinusitis within one otolaryngology department over a 15-year period. RESULTS: Thirty-four patients were identified, 26 with eosinophilic mucin rhinosinusitis and 8 with allergic fungal sinusitis. Orbital involvement at diagnosis was commoner in allergic fungal sinusitis patients (50 per cent) than eosinophilic mucin rhinosinusitis patients (7.7 per cent; p < 0.05). Asthma was diagnosed in 73 per cent of eosinophilic mucin rhinosinusitis patients and 37 per cent of allergic fungal sinusitis patients. CONCLUSION: Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis have the same clinical presentation but different clinical courses. The role of fungus and the ability to confirm its presence are still problematic issues, and additional studies are required.

Prevalence of rhinosinusitis among atypical cystic fibrosis patients.

The objective of this paper is to study the correlation between sinonasal involvement and type of cystic fibrosis (CF) in Israeli's CF patients. The comparative study includes 70 CF patients: 40 typical and 30 atypical CF patients. History and physical examination data were recorded, including endoscopic nasal examination as well as sinus computer tomography scan. The data collected from the two groups were statistically analyzed. Twenty-seven percent of atypical CF patients compared with 2.5% of typical CF patients had CF presenting symptoms of chronic rhinosinusitis (CRS) or obstructive nasal polyps (p < 0.001). Although severe CRS was found slightly more often in patient with atypical CF (43 vs. 32.5%), this difference did not reach statistical significance. Nine patients with severe CRS underwent endoscopic sinus surgery. Among these patients, six (66.6%) had atypical CF and only three (33.3%) had typical CF (p = 0.09). In conclusion, severe CRS is a common diagnosis among patients with typical and atypical CF disease. In the current study, no significant difference in the frequency of CRS was found between the two groups. High awareness toward the diagnosis of atypical CF, careful medical history focusing on sinonasal involvement and physical examination, including nasal endoscopy, for all CF patients (typical and atypical CF) may contribute to an early detection and treatment of significant sinonasal involvement, and may improve the quality of life of the patients.

[Neuroendocrine carcinoma with large cells of the breast: case report and review of the literature]. / Carcinome neuroendocrine à grandes cellules du sein : à propos d'un cas et revue de la littérature.

Neuroendocrine carcinoma with large cells is a slightly different tumor from the high rank of malignity. We report a case of breast localization in a 28-year-old patient. It is a locally advanced classified T4dN1M0 tumor that required neoadjuvant chemotherapy. The clinical answer was 75% of the level of the tumor. A standard surgery mastectomy with axillary lymph node dissection was realized, followed by external radiotherapy. The anatomopathologic and the immuno-histochemical study of the operational part confirmed the diagnosis of neuroendocrine carcinoma with large cells expressing the progesterone receptor. The patient is subjected to adjuvant hormonal treatment. After a 12 months retreat, a complete remission is maintained. Considering the scarcity of neuroendocrine carcinoma with large cells of the breast, the therapeutic standard is not yet available and the forecast remains difficult to determine.

A note on the use of conservation practices in U.S. agriculture.

This article measures the effect of an increase in productivity attributable to an increase in soil organic carbon associated with the increase in the use of conservation practices in agriculture in the United States. Both the direct and indirect effects are calibrated. The analytical approach used consists of a dynamic computable general equilibrium model composed of 14 producing sectors, 10 consuming sectors, seven household categories classified by income, and a government. The results suggest that the impact of a change in productivity is an increase in output over a six year period starting in 1998 in field crops. The most significant impact is felt in the livestock sector. This is because field crops are a major input in the production of livestock. The food processing sector also exhibits a relatively large increase because of the increase in inputs of both field crops and livestock. Manufacturing output increases primarily because overall investment rises and most investment utilizes manufacturing goods. The other producing sectors are generally unaffected by the increase in agricultural production due to an increase in soil organic carbon. Coincident with the increase in the production of field crops is a relatively large decrease in the price of field crops. Other noticeable price reductions occur in the livestock sector and the food processing sector. For the consuming sectors, the consumption of food and alcohol and tobacco increase but consumption in all of the other sectors remains basically unchanged. Prices in the food and alcohol and tobacco sectors decline by about 1% while the prices in the other sectors remain static. Household welfare increases in the aggregate by only 0.1% with this increase occurring uniformly across all household categories. Revenue received by the government increases a modest 2% in response to an increase in output and, hence, an increase in taxes paid. The results indicate that there are significant production benefits for several sectors that can be realized by an increase in the use of conservation practices in agricultural production which, in turn, enhances soil organic carbon. There are a number of policy options available to promote the use of conservation practices. These include education and technical assistance, financial assistance, research and development, land retirement, and regulation and taxes.

Conservation practices in U.S. agriculture and their impact on carbon sequestration.

Increase in the use of conservation practices by agriculture in the United States will enhance soil organic carbon and potentially increase carbon sequestration. This, in turn, will decrease the net emission of carbon dioxide. A number of studies exist that calibrate the contribution of various individual, site-specific conservation practices on changes in soil organic carbon. There is a general absence, however, of a comprehensive effort to measure objectively the contribution of these practices including conservation tillage, the Conservation Reserve Program, and conservation buffer strips to an change in soil organic carbon. This paper fills that void. After recounting the evolution of the use of the various conservation practices, it is estimated that organic carbon in the soil in 1998 in the United States attributable to these practices was about 12.2 million metric tons. By 2008, there will be an increase of about 25%. Given that there is a significant potential for conservation practices to lead to an increase in carbon sequestration, there are a number of policy options that can be pursued.

Endoscopic repair of choanal atresia: practical operative technique.

Choanal atresia is a well-known entity with various surgical approaches. The introduction of nasal endoscopic surgery made the endoscopic approach the most popular one because of excellent visualization and a good view of the choana to remove enough vomerian septal bone. Seven patients with choanal atresia were treated with 9 endoscopic procedures. Some practical operative details are described that can minimize the chance for restenosis.

Using insurance to enhance nitrogen fertilizer application to reduce nitrogen losses to the environment.

The advantage of using insurance to help a farmer adopt a best nitrogen management plan (BNMP) that reduces the impact of agricultural production on the environment is analytically and empirically demonstrated. Using an expected value analysis, it is shown that an insurance program can be structured so as to reduce a farmer's cost of bearing the adoption risk associated with changing production practices and, thus, to improve the farmer's certainty equivalent net return thereby promoting the adoption of a BNMP. Using the adoption of growing-season only N fertilizer application in Iowa as a case study, it is illustrated how insurance may be used to promote the adoption of this practice to reduce N fertilizer use. It is shown that it is possible for a farmer and an insurance company both to have an incentive to develop an insurance adoption program that will benefit both the farmer and the insurance company, increasing net social welfare and improving environmental quality in Iowa.

The environmental implications of soil erosion in the United States.

Soil erosion has both on-farm and off-farm impacts. Reduction of soil depth can impair the land's productivity, and the transport of sediments can degrade streams, lakes, and estuaries. Since 1933, soil conservation policies have existed in the United States. Originally they focused on the on-farm benefits of keeping soil on the land and increasing net farm income. Beginning in the 1980s, however, policy goals increasingly included reductions in off-site impacts of erosion. As a consequence of conservation efforts associated with explicit U.S. government policies, total soil erosion between 1982 and 1992 was reduced by 32% and the sheet and rill erosion rate fell from an average of 4.1 tons per acre per year in 1982 to 3.1 tons per acre in 1992 while the wind erosion rate fell from an average of 3.3 tons per acre per year to 2.4 tons per acre per year over the same period. Still, soil erosion is imposing substantial social costs. These costs are estimated to be about $37.6 billion annually. To further reduce soil erosion and thereby mitigate its social costs, there are a number of policy options available to induce farmers to adopt conservation practices including education and technical assistance. financial assistance, research and development, land retirement, and regulation and taxes.

The prognostic value of the tumour marker Cyfra 21-1 in carcinoma of head and neck and its role in early detection of recurrent disease.

This study examines a new tumour marker, Cyfra 21-1, as a prognostic marker in predicting the survival of H&N cancer patients, and its correlation with clinical outcome during prolonged follow up of these patients. The study included 67 patients with primary detection of carcinoma of H&N. The survival of these patients was evaluated in correlation with the disease stage and Cyfra 21-1 levels at initial diagnosis. 38 patients were followed clinically and with serial assays for at least 12 months, or until recurrence was diagnosed. Cyfra 21-1 levels were determined periodically, using an Elisa kit. Patients with Cyfra 21-1 < 1.5 ng ml(-1)had a higher survival rate compared to patients with Cyfra 21-1 > or = 1.5 ng ml(-1)(63% vs. 20%, respectively). The risk ratio of Ln(Cyfra 21-1) is 1.62 (P = 0.028). In a Cox regression model that included the disease stage and Ln(Cyfra 21-1), Ln(Cyfra 21-1) was preferred as the main parameter for predicting patients survival. In 83% of the 12 patients with recurrent or residual disease, Cyfra 21-1 was elevated before or during clinical detection of the recurrence. Cyfra 21-1 was found to be a prognostic marker for carcinoma of H&N, unrelated to the stage of the disease. Elevated levels of Cyfra 21-1 without clinical evidence of disease can be attributed to the marker's mean lead-time as compared to the clinical appearance of the disease.

Conservation practices in US agriculture and their implication for global climate change.

Increase in the use of conservation practices by agriculture in the United States will enhance soil organic carbon and potentially increase carbon sequestration. This, in turn, will decrease the net emission of carbon dioxide. A number of studies exist that calibrate the contribution of various individual, site-specific conservation practices on changes in soil organic carbon. There is a general absence, however, of a comprehensive effort to measure objectively the contribution of these practices including conservation tillage, the Conservation Reserve Program and conservation buffer strips to an change in soil organic carbon. This paper fills that void. After recounting the evolution of the use of the various conservation practices, it is estimated that organic carbon in the soil in 1998 in the United States attributable to these practices was approximately 12,200,000 metric tons. By 2008, there will be an increase of approximately 25%. Given that there is a significant potential for conservation practices to lead to an increase in carbon sequestration, there are a number of policy options that can be pursued. These include education and technical assistance, financial assistance, research and development, land retirement and regulation and taxes.

Acute mastoiditis in children: is surgical treatment necessary?

Acute mastoiditis in children remains an otological problem. Although the widespread use of antibiotics has reduced the need for surgical intervention, surgery is frequently used in the treatment of acute mastoiditis and its complications. The charts of 44 patients hospitalized with signs of acute mastoiditis were reviewed. In 43.2 per cent of all patients, acute mastoiditis was the presenting sign of acute middle-ear infection. Post-auricular erythema and protrusion of the auricle were the most frequent signs at presentation. All four signs (post-auricular erythema, oedema, tenderness, and protrusion of the auricle) were present in 40.9 per cent of patients. No bacterial pathogen was isolated in 45.5 per cent of ear cultures. Complicated acute mastoiditis was diagnosed in 13.7 per cent of the patients. Eighty-seven per cent of patients responded well to intravenous antibiotics and myringotomy, and in 11.4 per cent mastoidectomy or abscess drainage were performed. We conclude that nearly all patients with uncomplicated mastoiditis recover following intravenous antibiotics and myringotomy. Mastoidectomy should be performed in selected cases, such as cases of complicated acute mastoiditis.

Alternative measures of pesticide use.

While kilograms of pesticide is the most common way of measuring agricultural chemical use, the type of analysis will generally define what measure of chemical use is best. In this paper different measures are considered. The inferences one draws concerning pesticide use can vary substantially depending on the measure.

Alternative measures of pesticide use.

One kilogram of a pesticide is not necessarily equal to a kilogram of a different pesticide. This issue can be significant. Whether it is depends on the use to which pesticide-use data are put. While kilograms of pesticide is the most common way of measuring agricultural chemical use, the type of analysis will generally define what measure of chemical use is best. Quantifying the risk from the exposure to pesticides, for example, typically requires weighing usage or residues by acute or chronic health and environmental toxicity coefficients and subsequently estimating human or environmental exposure to such hazards. The interferences one draws concerning pesticide use can vary substantially depending on the measure considered.

[Flexible bronchoscopy in the diagnosis of foreign body aspiration].

Foreign body aspiration (FBA) should be suspected in every child with acute onset of cough or wheezing. Although a choking episode occurs in 80-90% of cases of FBA, it is not necessarily diagnostic. Furthermore, in many cases neither physical examination nor chest x-ray, including fluoroscopy, are diagnostic; their results may be completely normal in up to 17-25% of cases of FBA. Bronchoscopy is therefore mandatory when there is a convincing history of FBA, regardless of physical or radiologic findings. This can be done with either the flexible or rigid bronchoscope, or with both.

Cyfra 21-1. A new potential tumor marker for squamous cell carcinoma of head and neck.

OBJECTIVE: Evaluation of Cyfra 21-1 (cytokeratin fraction 21-1) in squamous cell carcinoma of the head and neck. DESIGN: Prospective study. PATIENTS: Serum Cyfra 21-1 concentration was measured in 250 samples from patients with squamous cell carcinoma of head and neck, patients with benign tumors of head and neck, healthy control subjects, and patients in remission from squamous cell carcinoma of head and neck. RESULTS: Cyfra 21-1 concentration was elevated in 60% of the new patients with squamous cell carcinoma but only in 8% of patients with benign tumors and 3.5% of the healthy controls. At a cutoff of 1.3 ng/mL, the sensitivity of the test was 60%, the specificity was 94%, positive predictive value was 75%, and negative predictive value was 89%. The marker levels tended to follow the clinical course of the disease and were useful for therapy monitoring. Cyfra 21-1 levels were in good correlation with the tumor stage expressed by the local (T) and the lymphatic spread (N) and were inversely correlated with histologic grade, eg, higher in poorly differentiated carcinoma than in well-differentiated squamous cell carcinoma. CONCLUSION: Cyfra 21-1 evaluation in head and neck squamous cell carcinoma is worthwhile for performance of an ample study that will prove and establish its routine use.