The Value of Spirometry in Subglottic Stenosis.

The diagnosis of subglottic stenosis (SGS) is usually made by clinical assessment and definitively by a direct endoscopic examination. This study aimed to evaluate different spirometric values in relation to anatomical grading and severity of subglottic stenosis cases of upper airway obstruction. Cases of SGS that underwent dilatational procedures endoscopically at the otolaryngology department of the King Saud University Medical City, Riyadh, Saudi Arabia, from June 2015 to October 2017 were collected. Pulmonary function test (PFT) pre- and postoperative parameters and the grades of subglottic stenosis were extracted. We compared different spirometric values to the severity of SGS and compared the pre- and postoperative results for each patient. There were 19 cases with a valid PFT study within 7 days preoperatively in addition to a documented intraoperative grading according to the Myer-Cotton grading system; 7 (36.8%) were grade 1, 8 (42.1%) were grade 2, and 4 (21.1%) were grade 3. The actual preoperative ratio of forced expiratory volume (FEV1) in 1 second to peak expiratory flow (PEF) for all 19 patients ranged from 7.34 to 21.40 mL/L/min. We found a significant improvement in all spirometric parameters postdilatation including PEF ( P < .001), FEV1 ( P < .001), FEV1/PEF ( P = .001), forced expiratory flow (FEF) from 25%, 50%, and 75% of vital capacity, respectively, FEF25 ( P < .001), FEF50 ( P = .001), FEF75 ( P = .048), and maximum mid-expiratory flow ( P = .002). We did not find any correlation between the severity of stenosis and spirometric values. This study revealed that spirometry is a useful marker in following up patients with subglottic stenosis and is also a good indicator to determine postairway surgery outcomes. However, these markers do not correlate with anatomical grading and the severity of subglottic stenosis.

A midline nasopharyngeal heterotopic neuroglial tissue.

Glial heterotopia is a rare disorder. However, it must be considered in the differential diagnosis of airway obstruction in the newborn. Differentiation of this lesion from nasal glioma and encephalocele is important. In this paper we report a midline glial heterotopia, which presented with upper airway obstruction in a newborn. The origin of a glial heterotopia from the midline of the nasopharynx has not been reported before. We present a review of the literature and discuss the clinical, radiological and pathological features of nasopharyngeal brain heterotopia in an infant.

Thorium and iodine memory effects in inductively-coupled plasma mass spectrometry.

Thorium and iodine memory effects have been characterized experimentally for inductively-coupled plasma mass spectrometry by adding ammonia gas directly to the spray chamber and nebulizing aqueous ammonia sample solutions to assess analyte memory retention sites. Thorium memory effect originates from the tendency of an unidentified thorium compound to volatilize from the spray-chamber walls, and not from Th compound adsorption to nebulizer tubing. The mass spectrometer skimmer and sampler cones, ion optics, quadrupole, and other components are not responsible for the memory effect. Unlike that of thorium the iodine memory effect originates from adsorption of iodine compounds on nebulizer tubing surfaces and from volatilization of HI and I2 from the spray-chamber walls. Addition of ammonia sample solutions or ammonia gas directly to the spray chamber eliminated the Th and I memory effects in practical analyses, and blank levels were achieved after 2 min wash-outs. Quantitative recoveries were obtained for Th and I in reference materials.

Recurrent temporal petrositis.

The objective of this paper is to present and discuss the common features of temporal petrositis and the different approaches to its management. Petrositis used to be common before the antibiotic era. It can be associated with life-threatening complications. The management of this problem used to be by an aggressive surgical approach. However, recent reports are describing good results with more conservative medical treatment and minimal surgical intervention, with the reservation of more aggressive surgical interventions for chronic or refractory cases.

Langerhans' cell histiocytosis: paediatric head and neck study.

OBJECTIVE: This study presents the experience of the Montreal Children's Hospital (MCH) with Langerhans' cell histiocytosis (LCH) and reviews the new advances in diagnosis and therapy of this disorder. DESIGN: Retrospective study of 20 patients seen between July 1986 and July 1997 diagnosed with LCH. METHODS: All of the 20 charts were examined for variables including age, sex, area involved, treatment modalities, and complications. RESULT: Sixty-five percent of patients presented with localized lesions and 35% with multisystem involvement. The most common involved area was the skull, and 57% of skull lesions involved frontal bone. The temporal bone was involved in 25% of cases. The most common ear symptom was otorrhea. CONCLUSION: Langerhans' cell histiocytosis is a rare paediatric disorder. Head and neck involvement occurs frequently in both localized and multisystem disease. The prognosis is highly dependent on the age and number of systems involved.

Otitis externa malignant. A case report and review of literature.

Otitis externa malignant (OEM) is a virulent infection if it is not diagnosed and treated promptly. Its mortality rate was reported to be 53% when there is associated facial nerve paralysis. It usually affects elderly diabetic patients, who present with deep-seated pain and other features of non-resolving otitis externa. It is mostly caused by Pseudomonas (P) aeruginosa and the treatment of choice is anti-Pseudomonas antibiotic. A 64-year-old diabetic male patient is described who presented with left ear pain and discharge for two months and did not respond to ordinary treatment. The patient also noticed a progressive facial weakness on the same side. The clinical presentation, investigations, treatment and follow-up of the OEM are discussed on the basis of our case and the review of the literature. The diagnosis of OEM is based on high index of suspicion and confirmed by histopathologic changes and radionuclide studies. Gallium 67 citrate scan is a sensitive way to diagnose and follow up the regression of the disease in response to the medical treatment. Ciprofloxacin is the treatment of choice; however, it has to be in accordance to culture and sensitivity results.

[Arrhythmogenic effect of ajmaline on the atrial level]. / Etude de l'effet arythmogène de l'ajmaline à l'étage auriculaire.

The aim of this study was to determine whether an antiarrhythmic, Ajmaline, could have proarrhythmic effects on the atrium and to compare the results with those of other antiarrhythmic drugs. A total of 1950 patients without cardiac failure or recent (less than 6 weeks) myocardial infarction were given 1 mg/kg of Ajmaline intravenously during electrophysiological investigation. A proarrhythmic effect was defined as the occurrence of supraventricular tachycardia (SVT) in a patient without this arrhythmia before the test or the facilitation of its induction. Fifty five patients developed SVT (mainly atrial tachyarrhythmias: 48 cases, and some junctional tachycardia: 7 cases) which occurred spontaneously in 22 patients and during fixed atrial pacing in 33 patients. Fifteen patients developed ventricular tachycardia (VT). The predisposing factors for the development of SVT were: a previous history suggesting spontaneous SVT (28 patients; 51 p. 100); sinoatrial block (14 patients--the only abnormality in 10 cases). Seventeen patients had none of these factors but 8 had known cardiac pathology and the other 9 were relatively elderly patients (79 years). Twelve of the patients developing VT had known cardiac disease, bundle branch block in 12 cases and previous VT in 6 cases. In conclusion, proarrhythmic effects of Ajmaline are infrequent if its contraindications are respected, but they do exist at both atrial (2.8 p. 100) and ventricular levels (0.8 p. 100): the risk factors are comparable: previous spontaneous arrhythmias or ECG changes (SA block at the atrial and bundle branch block at the ventricular level).