Treatment strategies for inverted papillomas with intracranial or intraorbital involvement.

OBJECTIVE: Sinonasal inverted papillomas are challenging benign tumours of the nasal cavity because of their high recurrence rates and the lifetime malignant transformation risk of 10 per cent as well as their locally aggressive behaviour. This study aimed to describe treatment strategies for inverted papillomas with intracranial or intraorbital involvement. METHOD: This was a prospective case series study of 18 patients with inverted papilloma with intracranial or intraorbital involvement. Patient demographic data, imaging, pathology, surgical technique and recurrences were recorded prospectively over a period of seven years. RESULTS: A total of 83 per cent of the patients in this study had been previously operated on, consisting of 8 cases with intracranial involvement, 1 case with intraorbital involvement and 9 with both. During follow up with a medium of 37 months (range, 13-115 months) there were two recurrences. CONCLUSION: It was postulated that intracranial or intraorbital involvement observed in this series was the result of multiple revisions. However, using accurate imaging protocols and the pedicle-oriented approach for tumour excision, complete tumour removal was achieved in most cases with minimal post-operative complications.

Ecchordosis physaliphora: a cautionary tale.

BACKGROUND: Ecchordosis physaliphora is a congenital, benign lesion originating from notochordal remnants along the craniospinal axis, most frequently located at the level of the clivus and sacrum. Sometimes ecchordosis physaliphora is difficult to recognise and treat, with a total of twenty-six cases described in the literature. METHODS: This study reports on three cases of previously undiagnosed ecchordosis physaliphora presenting with cerebrospinal fluid rhinorrhoea and meningitis. CONCLUSION: Endoscopic transclival or transsphenoid surgery including three-layer (fat, fascia and nasoseptal flap) reconstruction was used in all cases with complete resolution of the symptoms.

Social Factors in the Development of Chronic Rhinosinusitis: a Systematic Review.

PURPOSE OF REVIEW: In an era where prevention is paramount, understanding social factors for chronic rhinosinusitis (CRS) may facilitate preventive interventions that mitigate risk factors associated with the initiation or progression of the disease. RECENT FINDINGS: Both passive and active smoking are clearly and unequivocally associated with both the incidence and the severity of rhinosinusitis, while there an increasing body of evidence linking social deprivation and low socioeconomic status with rhinosinusitis and its complications. However, overall, only a handful of studies were longitudinal, while the available studies suffer from lack of standardized definitions of rhinosinusitis. In this systematic review, we assessed the available evidence linking CRS with social factors, such as socioeconomic status and class, educational status, family status, living and working location and conditions, and use of toxins or recreational drugs as well as exercise and diet. Thirty studies from 1995 onwards fulfilled our inclusion criteria and were used for this review. Social deprivation and low socioeconomic level seem to be directly associated with rhinosinusitis, as there are pollutants in living or working environment. A clear and direct association between smoking (both active and passive) and rhinosinusitis was also shown. However, the link between rhinosinusitis and education level, and exercise and diet, if any, seems to be more complex.

EEG correlates of cerebral engagement in reading tasks.

This study evaluated the utility of electroencephalographic (EEG) measures as indices of regional cerebral engagement activation during reading in neurologically intact adult volunteers. EEG was recorded from 16 scalp locations as participants performed four visual detection tasks designed to tap into increasingly more complex operations regularly involved in reading, namely visual-spatial, orthographic, phonological, and semantic. EEG records were quantified using power spectrum measures in four frequency bands (delta, theta, alpha, beta1, and beta2), in addition to a non-linear estimate of signal complexity (prediction error). Results showed that (1) changes in spectral power between pairs of reading tasks, and (2) regional variations in EEG measures for each task, were restricted to signals recorded over the left hemisphere. These findings are in agreement with knowledge regarding left hemisphere involvement in higher level component processes of reading.

Usefulness of non-linear EEG analysis.

Spectral analysis methods are useful for the evaluation of EEG signals. Nevertheless, they refer only to the frequency domain and ignore any potentially interesting phase information. Analytical methods based upon the theory of nonlinear dynamics provides this and additional information. We used both methods to evaluate the EEG signals of volunteers performing two distinct mental arithmetic tasks. We extracted the power spectrum, the coherence and nonlinear parameters (dimension, the first Lyapunov exponent, the Kolmogorov entropy, the mutual dimension and the dimensions based upon spatial embedding of the original data as well as their surrogates). We found that 1) the spatial embedding dimension differed from that of the surrogates, indicating nonlinearity, 2) there were differences between the two arithmetic tasks, and 3) the spectral and nonlinear methods differ in terms of the information they provide. Our results indicate that nonlinear analysis methods can be useful despite the fact that they are still at an early stage of development.

Study of late potentials and ventricular arrhythmias in hypertensive patients with normal electrocardiograms.

INTRODUCTION: Although an increase in the occurrence of ventricular arrhythmias has been observed in hypertensive patients, some basic questions remain unresolved regarding the prevalence and the pathophysiology of these arrhythmias. The basic aims of this study were as follows: (1) to examine the incidence and severity of ventricular arrhythmias in a substantial number of hypertensive patients without electrocardiographic indications of hypertrophy; and (2) to examine the correlation between late potentials, hypertrophy, and ventricular arrhythmias in these patients. MATERIALS AND METHODS: We studied 78 consecutive patients (31 men, 47 women), aged 60.5 +/- 7.8 years, with a history of hypertension but a normal electrocardiogram. All patients had an echocardiographic study, 24-hour ambulatory monitoring, exercise test, and signal-averaged electrocardiogram. The latter was analyzed using a 40- to 250-Hz filter and with a noise level < or = 0.3 microV. RESULTS: Of the 78 patients studied, 21 (26.9%) had severe ventricular arrhythmias, while 57 (73.1%) had either no ventricular ectopics or sporadic isolated ventricular extrasystoles. Left ventricular hypertrophy, defined by echocardiography, was found in 58 patients (74.3%), of which 16 (27.58%) had severe ventricular arrhythmias. Five (25%) of the 20 patients without hypertrophy also had severe ventricular arrhythmias (P = NS). Ventricular late potentials were recorded in 19 (24.5%) of the 78 patients. Of these, 11 (57.89%) had severe arrhythmias, while of the 59 patients without late potentials 10 (16.94%) had severe ventricular ectopic activity. CONCLUSIONS: In hypertensive patients without electrocardiographic signs of hypertrophy, the higher prevalence of ventricular arrhythmias does not appear to be related to left ventricular hypertrophy but is correlated with the existence of ventricular late potentials.