Long-Term Outcomes of Definitive Chemoradiotherapy for Early-Stage Extranodal Natural Killer/T-cell Lymphoma, Nasal Type: A Retrospective Analysis From a Single Center.

Background Nasal extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is a rare type of lymphoma with characteristic histological features. Although radiotherapy can achieve a high response rate, long-term efficacy and safety are yet to be established. Methodology Using electronic health records, we identified relevant patients treated at our hospital from August 2005 to August 2015. We enrolled patients with pathologically confirmed ENKTL treated with curative intent radiotherapy. Results We included 13 patients who underwent definitive radiotherapy in the analysis, comprising 11 males and 2 females and a median age of 53 years (range: 28-73). The median follow-up period was 113.4 months. The overall survival at 5 and 10 years was 92.3% (95% confidence interval [CI]: 57-99 %) and 68.4% (95% CI: 29-89 %), respectively. The most common radiation-related late-term toxicity was sinus disorder (Grade 1-2) in 11 patients (85%). Radiation-related grade 3 to 5 toxicities were not observed. Conclusion The present retrospective study elucidated the long-term safety and effectiveness of curative intent radiotherapy in patients with localized ENKTL.

Importance of the numerical schemes in the CFD of the human nose.

Computational fluid dynamics of the air flow in the human nasal cavities, starting from patient-specific Computer Tomography (CT) scans, is an important tool for diagnostics and surgery planning. However, a complete and systematic assessment of the influence of the main modelling assumptions is still lacking. In designing such simulations, choosing the discretization scheme, which is the main subject of the present work, is an often overlooked decision of primary importance. We use a comparison framework to quantify the effects of the major design choices. The reconstructed airways of a healthy, representative adult patient are used to set up a computational study where such effects are systematically measured. It is found that the choice of the numerical scheme is the most important aspect, although all varied parameters impact the solution noticeably. For a physiologically meaningful flow rate, changes of the global pressure drop up to more than 50% are observed; locally, velocity differences can become extremely significant. Our results call for an improved standard in the description of this type of numerical studies, where way too often the order of accuracy of the numerical scheme is not mentioned.

A Nasal Complication of Nasopharyngeal Swab for Reverse Transcription Polymerase Chain Reaction (RT-PCR) Detection of SARS-CoV-2 mRNA.

Nasopharyngeal (NP) and oropharyngeal (OP) specimens in the detection of the SARS-Cov-2 RNA are considered to have the highest diagnostic sensitivity and they have been recommended by the World Health Organization as the most reliable test. However, collecting NP specimens require specialized operators and adequate technique. We describe an intranasal breaking of the nasopharyngeal swab for anatomical reasons needing a surgical removing. We conclude that a safely procedure needs possibly a check for septal deviations or other causes of nasal obstruction.

Comparison of micron- and nano-particle transport in the human nasal cavity with a focus on the olfactory region.

Intranasal administration of drugs serves as a promising, noninvasive option for the treatment of various disorders of the central nervous system and upper respiratory tract. Predictive, ie, realistic and accurate, particle tracking in the human nasal cavities is an essential step to achieve these goals. The major factors affecting aerosol transport and deposition are the inhalation flowrate, the particle characteristics, and the nasal airway geometry. In vivo and in vitro studies using nasal cavity casts provide realistic images regarding particle-deposition pattern. Computational Fluid-Particle Dynamics (CF-PD) studies can offer a flexible, detailed and cost effective solution to the problem of direct drug delivery. The open-source software OpenFOAM was employed to conduct, after model validation, laminar and turbulent fluid-particle dynamics simulations for representative nasal cavities. Specifically, micron particles and nanoparticles were both individually tracked for different steady airflow rates to determine sectional deposition efficiencies. For micron particles, inertial forces were found to be the dominating factor, resulting in higher deposition for larger particles, mainly due to impaction. In contrast, diffusional effects are more important for nanoparticles. With a focus on the olfactory region, the detailed analysis of sectional deposition concentrations, considering a wide range of particle diameters, provide new physical insight to the particle dynamics inside human nasal cavities. The laminar/turbulent Euler-Lagrange modelling approach for simulating the fate of nanoparticles form a foundation for future studies focusing on targeted drug delivery. A major application would be direct nanodrug delivery to the olfactory region to achieve large local concentrations for possible migration across the blood-brain-barrier.

Rorqual whale nasal plugs: protecting the respiratory tract against water entry and barotrauma.

The upper respiratory tract of rorquals, lunge-feeding baleen whales, must be protected against water incursion and the risk of barotrauma at depth, where air-filled spaces like the bony nasal cavities may experience high adverse pressure gradients. We hypothesize these two disparate tasks are accomplished by paired cylindrical nasal plugs that attach on the rostrum and deep inside the nasal cavity. Here, we present evidence that the large size and deep attachment of the plugs is a compromise, allowing them to block the nasal cavities to prevent water entry while also facilitating pressure equilibration between the nasal cavities and ambient hydrostatic pressure (Pamb) at depth. We investigated nasal plug behaviour using videos of rorquals surfacing, plug morphology from dissections, histology and MRI scans, and plug function by mathematically modelling nasal pressures at depth. We found each nasal plug has three structurally distinct regions: a muscular rostral region, a predominantly fatty mid-section and an elastic tendon that attaches the plug caudally. We propose muscle contraction while surfacing pulls the fatty sections rostrally, opening the nasal cavities to air, while the elastic tendons snap the plugs back into place, sealing the cavities after breathing. At depth, we propose Pamb pushes the fatty region deeper into the nasal cavities, decreasing air volume by about half and equilibrating nasal cavity to Pamb, preventing barotrauma. The nasal plugs are a unique innovation in rorquals, which demonstrate their importance and novelty during diving, where pressure becomes as important an issue as the danger of water entry.

Radiation-Induced Rhinitis: Cytological and Olfactory Changes.

BACKGROUND: Oral mucositis is a well-known adverse event of radiotherapy (RT) for head and neck cancer (HNC). Its nasal counterpart, the radiation-induced rhinitis, is poorly studied and considered in clinical practice. OBJECTIVE: The aim of this observational study was to evaluate acute cytological and olfactory alterations during RT and their correlation with RT doses. METHODS: Ten patients who underwent RT for HNC, excluding tumors of the nasal cavities, were evaluated with nasal scraping for cytological examination, Sniffin' Sticks test for olfactory assessment, and Nasal Obstruction Symptom Evaluation scale. The examinations were performed before (T0), at mid-course (T1), and at the end (T2) of RT. They were repeated 1 and 3 months after RT (T3 and T4). Mean dose (Dmean) and near maximum dose (D2%) to nasal cavities and inferior turbinates were used for correlation analyses. RESULTS: Radiation-induced rhinitis was present in 70% of patients at T2, and it was still observed in 40% of cases after 3 months. Although olfactory function remained within the normal range at the evaluated times, a significant decrease in odor threshold and discrimination was observed during RT, which returned to baseline levels after RT. Nasal cytology showed a radiation-induced rhinitis with neutrophils and sometimes bacteria. Mucous and squamous cell metaplasia appeared in 10% of patients. Dmean and D2% to inferior turbinates were associated to neutrophilic rhinitis at T2, and D2% to inferior turbinates was correlated to mucous cell metaplasia at T2. CONCLUSIONS: RT for HNC induces acute rhinitis that may persist after the completion of treatment and can affect patient's quality of life. Nasal cytology can help to choose the best treatment on an individual basis.

Characteristics and outcome of impacted button batteries among young children less than 7 years of age in China: a retrospective analysis of 116 cases.

BACKGROUND: Ingestion of button batteries occurs in about ten persons per one million persons each year, with most of them children, and one in every 1000 battery ingestions leads to serious injuries. This study aimed to describe the clinical features and outcome of ingestion or inhalation of button batteries in children spanning a decade from January, 2006 to December, 2016 at a tertiary care hospital. METHODS: We reviewed the clinical records of children who sought treatment for inhaled or ingested button batteries at our hospital during the study period. Data on gender, age, time from ingestion to treatment, site of impaction, imaging findings, and outcomes were retrieved and analyzed. RESULTS: We identified 116 pediatric cases of ingestion or inhalation of button batteries. Their mean age was 26 months. The time from ingestion or inhalation of button batteries to treatment was 0.5 hours to 2 weeks. Ninety-seven (83.6%) button batteries were located in the nasal cavity, 13 (11.2%) in the gastrointestinal (GI) tract including 6 in the esophagus, and 7 in the stomach and lower GI tract, and 6 (5.2%) in the auditory tract. Twenty-one (21.6%) children with nasal button batteries had preoperative septal perforations and one (1.0%) had postoperative septal perforation. One child with esophageal button battery developed esophageal stricture and one died of sudden cardiac arrest perioperatively. One child had auditory damages in the right tympanic membrane and ossicles. CONCLUSIONS: Inhalation or ingestion may occur in the nasal cavities, the esophagus and GI tract and the auditory tract. Prompt diagnosis and treatment are required for a satisfactory outcome and ingested or inhaled button batteries require different treatment protocols.

Robust nondimensional estimators to assess the nasal airflow in health and disease.

There are significant variations of both human nose shapes and airflow patterns inside nasal cavities, so it is difficult to provide a comprehensive medical identification using a universal template for what otolaryngologists consider normal breathing at rest. In addition, airflow patterns present even more random characteristics in diseased nasal cavities. To give a medical assessment to differentiate the nasal cavities in health and disease, we propose 2 nondimensional estimators obtained from both medical images and computational fluid dynamics. The first mathematical estimator ϕ is a function of geometric features and potential asymmetries between nasal passages, while the second estimator R represents in fluid mechanics terms the total nasal resistance that corresponds to the atmosphere-choana pressure drop. These estimators only require global information such as nasal geometry and magnitudes of flow determined by simulations under laminar conditions. We find that these estimators take low and high values for healthy and diseased nasal cavities, respectively. Our study, based on 24 healthy and 25 diseased Caucasian subjects, reveals that there is an interval of values associated with healthy cavities that clusters in a small region of the plane ϕ-R. Therefore, these estimators can be seen as a first approximation to provide nasal airflow data to the clinician in a noninvasive method, as the computed tomography scan that provides the required images is routinely obtained as a result of the preexisting naso-sinusal condition.

Nasal foreign bodies in children in a pediatric hospital in Senegal: A three-year assessment.

OBJECTIVES: Nasal foreign bodies (NFB) constitute a common domestic accident in children. The objectives of the present study were to report the particularities of NFBs in children presenting at a pediatric hospital in Senegal, and to describe our therapeutic attitude. MATERIAL AND METHODS: A retrospective descriptive study included all under-15 year-olds presenting with NFB in the ENT department of the National Children's Hospital Center of Diamniadio, Senegal, between January 1, 2013 and December 31, 2015. Study variables comprised: age, gender, provenance, presenting symptoms, time to consultation, type of NFB, extraction method, and complications. RESULTS: 58 NFB cases were retrieved. Mean age was 3years 4months; 93% of patients were under 5 years old. There was female predominance of 53.45%: i.e., sex-ratio, 0.87. Location was in the right cavity in 43 patients (74.1%). The presenting symptom was purulent rhinorrhea in 51.7% of cases. Time to consultation was within 24hours in 17.24% of cases. NFB type was firstly foam rubber (29.3%), followed by grain (20.7%). Extraction was performed in consultation in 84.5% of cases and in the operating room in 15.5%. Morbidity was 22.41%: 17.24% epistaxis and 5.17% nasal infection. CONCLUSION: NFBs constitute a common domestic accident in under-5 year-olds. The rural Senegalese context shows delay in consultation.

Oestrus ovis larvae in nasal cavity of sheep: a case report.

The present communication reports the infestation of nasal cavities of sheep by larvae of Oestrus ovis from Kashmir Valley.

Is there a correlation between nasal septum deviation and maxillary transversal deficiency? A retrospective study on prepubertal subjects.

INTRODUCTION: Deviated nasal septum may cause a reduction of the nasal airflow, thus, during the craniofacial development, a reduced nasal airflow could originate a chronic mouth-breathing pattern, related with moderate to severe maxillary constriction. The aim of this retrospective study is to analyze the correlation between maxillary transverse deficiency and nasal septum deviation. METHODS: Frontal cephalograms were performed on 66 posterior-anterior radiographs of subjects (34M, 32F; mean age 9.95±2.50 years) with maxillary transverse deficiency and on a control group of 31 posterior-anterior radiographs of subjects (13M, 18F; 9.29±2.08 years). Angular parameters of the nasal cavities were recorded and compared between the two groups using a Student's t-test. RESULTS: Generally all the parameters are very similar between the two groups except for the ASY angle that differs for about the 27%; anyway the Student's t-test showed no statistically significant differences between the two groups (mostly p>0.20). CONCLUSIONS: This study failed to show an association between transverse maxillary deficiencies and nasal septum deviations. Moreover, no significant differences were found between the mean nasal cavities dimensions in subjects with transverse maxillary deficiency and the control group.

Effects of CT resolution and radiodensity threshold on the CFD evaluation of nasal airflow.

The article focuses on the robustness of a CFD-based procedure for the quantitative evaluation of the nasal airflow. CFD ability to yield robust results with respect to the unavoidable procedural and modeling inaccuracies must be demonstrated to allow this tool to become part of the clinical practice in this field. The present article specifically addresses the sensitivity of the CFD procedure to the spatial resolution of the available CT scans, as well as to the choice of the segmentation level of the CT images. We found no critical problems concerning these issues; nevertheless, the choice of the segmentation level is potentially delicate if carried out by an untrained operator.

Clinical outcome and prognosis of patients with primary sinonasal tract diffuse large B-cell lymphoma treated with rituximab-cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy: a study by the Consortium for Improving Survival of Lymphoma.

We evaluated the clinical outcomes and relapse patterns of 80 patients with primary sinonasal tract diffuse large B-cell lymphoma (SN-DLBCL) treated with rituximab-cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) chemotherapy at 22 institutions. A total of 59 (73.8%) patients received R-CHOP chemotherapy alone, whereas 21 (26.3%) were treated with R-CHOP followed by involved field radiotherapy (IFRT). In 73 patients with Ann Arbor stage I-II disease, no significant difference was found in the response rate or overall survival (OS) between R-CHOP alone (n = 52) and R-CHOP followed by IFRT (n = 21). Among 11 relapsed patients in this study, the most common pattern of relapse was local (n = 8, 11.8%), whereas central nervous system (CNS) relapse was observed in only one (1.9%) patient. These results suggest that patients with primary SN-DLBCL treated with R-CHOP have a relatively low CNS relapse rate and better OS compared to previous studies before the introduction of R.

Traumatismo nasal con arpón de pesca / Nasal trauma caused by fishing harpoon

Paciente masculino de 60 años de edad con trauma nasal accidental, producido por un arpón de pesca que penetra a través de la fosa nasal izquierda. Este fue atendido de urgencia y se le removió el arpón mediante una rinoscopia anterior. El paciente evolucionó de forma satisfactoria y no hubo afectación de gravedad ni secuelas. Los traumatismos en el macizo facial y craneoencefálico, producidos por armas diferentes a las de fuego, son poco frecuentes. El tipo de lesión presentada es algo excepcional y no existen informes similares en la literatura(AU)

A sixty-year old male patient, who suffered nasal trauma caused by a fishing harpoon that penetrated his left nasal cavity. He was immediately assisted to remove the hapoon by performing anterior rhinoscopy. He recovered satisfactorily and there were no side effects or sequelae. The facial and cranioencephalic traumas caused by weapons different from firearms are rare. The type of lesion presented in this article is unique and there is no similar reports found in literature(AU)

Traumatismo nasal con arpón de pesca / Nasal trauma caused by fishing harpoon

Paciente masculino de 60 años de edad con trauma nasal accidental, producido por un arpón de pesca que penetra a través de la fosa nasal izquierda. Este fue atendido de urgencia y se le removió el arpón mediante una rinoscopia anterior. El paciente evolucionó de forma satisfactoria y no hubo afectación de gravedad ni secuelas. Los traumatismos en el macizo facial y craneoencefálico, producidos por armas diferentes a las de fuego, son poco frecuentes. El tipo de lesión presentada es algo excepcional y no existen informes similares en la literatura.

A sixty-year old male patient, who suffered nasal trauma caused by a fishing harpoon that penetrated his left nasal cavity. He was immediately assisted to remove the hapoon by performing anterior rhinoscopy. He recovered satisfactorily and there were no side effects or sequelae. The facial and cranioencephalic traumas caused by weapons different from firearms are rare. The type of lesion presented in this article is unique and there is no similar reports found in literature.

Molecular identity and prevalence of Cryptococcus spp. nasal carriage in asymptomatic feral cats in Italy.

Cryptococcosis is a life-threatening fungal disease that infects humans and animals worldwide. Inhalation of fungal particles from an environmental source can cause primary infection of the respiratory system. As animals can be considered a sentinel for human diseases, the aim of this study was to determine the prevalence and molecular identity of Cryptococcus spp. in the nasal cavity of feral cats. Cats from 162 urban and rural feral cat colonies were sampled over 3 years. Of 766 cats from which nasal swabs were obtained, Cryptococcus spp. were recovered from 95 (12.6%), including 37 C. magnus (4.8%), 16 C. albidus (2.0%), 15 C. carnescens (1.9%), 12 C. neoformans (1.6%), as well as C. oeirensis (n = 3), C. victoriae (n = 3), C. albidosimilis (n = 2), Filobasidium globisporum (n = 2), C. adeliensis (n = 1), C. flavescens (n = 1), C. dimnae (n = 1), C. saitoi (n = 1), and C. wieringae (n = 1) with prevalence <1%. Thirteen Cryptococcus species were identified by polymerase chain reaction and sequencing of internal transcribed spacer amplicons. Statistical analysis did not identify any predisposing factors that contributed to nasal colonization (eg, sex, age, season, or habitat). Results suggest that asymptomatic feral cats may carry C. neoformans and other Cryptococcus species in their sinonasal cavity. Genotyping of the specific cryptococcal isolates provides a better understanding of the epidemiology of these yeasts.

Endoscopic sinus surgery in individuals with facial pain due to chronic maxillary sinusitis ? a functional controlled study / Cirurgia endoscópica de seio da face em indivíduos com dor facial devida a sinusite maxilar crônica ? um estudo funcional controlado

Objective: To measure the intra-sinus pressure and the maxillary sinus functional efficiency (MSFE) in individuals with chronic facial pain after conservative or conventional endoscopic maxillary surgery, as well as in controls. Method: Sinus manometry was performed 5 times during inhalation. Results: The resemblance of pressure values comparing those treated with minimally invasive surgery and controls was remarkable, while traditional surgery significantly decreased intrasinusal pressures. The MSFE was 100% in the three tested times for controls, close to that in those submitted to minimally invasive surgery (98.3%, 98.8%, and 98.0%) and significantly impaired after conventional surgery (48.8%, 52.1%, 48.5 %, p<0.01). All patients submitted to minimally invasive surgery remained pain-free after three months of surgery, relative to 46.7% of the submitted to conventional surgery (p<0.05). Conclusion: Minimally invasive sinus surgery is associated with functionality of the chambers that resemble what is found in normal individuals. .

Objetivo: Medir a pressão intrasinusal e a eficiência funcional do seio maxilar (EFSM) em indivíduos com dor facial crônica após cirurgia endoscópica maxilar conservadora ou convencional em comparação a pessoas normais. Método: A manometria do seio foi feita 5 vezes durante a inalação. Resultados: A semelhança entre os valores das pressões comparando aqueles tratados com cirurgia minimamente invasiva e os controles foi notável, enquanto que na cirurgia tradicional houve diminuição significativa das pressões intrasinusais. A EFSM foi 100% nas três vezes testadas nos controles, de modo muito semelhante ao que foi observado naqueles submetidos a cirurgia minimamente invasiva (98,3%, 98,8%, e 98,0%) e significativamente diminuída naqueles submetidos a cirurgia convencional (48,8%, 52,1%, 48,5 %, p<0,01). Todos os pacientes submetidos a cirurgia minimamente invasiva mantiveram-se sem dor três meses depois da cirurgia, comparados a 46,7% naqueles submetidos a cirurgia convencional (p<0,05). Conclusão: Cirurgia minimamente invasiva está associada a funcionalidade das câmaras sinusais que se assemelha ao que é observado em indivíduos normais. .

Adenoid cystic carcinoma of the paranasal sinuses: retrospective series and review of the literature.

OBJECTIVES: Adenoid cystic carcinomas (ACC) are rare malignant tumours arising in the major and minor salivary glands. Involvement of the nasal cavity and paranasal sinuses is rare and poorly described. The purpose of this study was to define the clinical and prognostic criteria of ACC of the paranasal sinuses based on the review of a series of 25 cases. MATERIAL AND METHODS: Single-centre retrospective study of 25 cases of ACC of the paranasal sinuses managed between 1998 and 2011, evaluating epidemiological, clinical, diagnostic and prognostic criteria. Factors influencing survival (Kaplan-Meier/Log Rank test) and the patient's quality of life (EORTC QLQ-C30 questionnaire) were also analysed. RESULTS: Most patients (72%) had a locally-advanced tumour (stage T3 or T4) at diagnosis. Tumour sites, in decreasing order of frequency, were the maxillary sinus, nasal cavities and ethmoid sinus. The most common presenting complaints were maxillary pain or heaviness, unilateral blocked nose, and repeated epistaxis. When the tumour was resectable, treatment comprised a combination of surgery and adjuvant radiotherapy. The 5-year overall survival rate was 63% and the 5-year disease-free survival rate was 43%. The TNM stage at diagnosis (P=0.03), the histological subtype (P=0.023), the possibility of combined surgery and radiotherapy (P=0.03), and local control (P=0.05) were significant factors of improved 5-year overall survival. Positive surgical margins were associated with a trend towards poorer 5-year disease-free survival (ns). CONCLUSIONS: ACC are rare malignant tumours associated with a poor prognosis, characterized by a high recurrence rate. Recommended treatment is a combination of surgery and adjuvant radiotherapy whenever possible. Five-year survival varies as a function of TNM stage, histological subtype, treatment options and local control.