[Effect of the external nasal dilator breathe right and nasal cycle influence].

The external nasal dilator Breathe Right is a nonprescription disposable mechanical device worn over the bridge of the nose that supports the outer walls of the nasal vestibule to increase cross-sectional nasal valve area and enhance air flow through the nose. When worn, the device applies a gentle outward pull to the outside walls of the nasal vestibule that helps prevent collapse of the lateral walls of the nasal vestibule. The device appears similar to an adhesive bandage with two polyester springs attached lengthwise to the nonadhesive side of the backing material. The form of the external nose varies significantly between racial groups and some comment is possible about the form of the nasal valve, i.e., Caucasian noses are leptorrhine, Negroid noses platyrrhine, and Oriental noses intermediate. A question exists about whether Breathe Right is as effective in Japanese as in Caucasians against nasal obstruction. We measured the effect by acoustic rhinometry in 35 healthy subjects. We measured 2 cross-sectional areas-the I-notch and C-notch-and 3 nasal volumes-V(0-1), from 0 to 1 cm corresponding to the I-notch, V(1-3), from 1 to 3cm corresponding to the C notch, and V (3-6), from 3 to 6cm. We studied the influence of the nasal cycle on the effect of Breathe Right in the nasal cavity. We evaluated subjects in a stable sitting position before applying Breathe Right, after using 5 minutes, and in a free interval of 25 minutes following. The experiment was repeated 10 times. We found that Breathe Right increases the nasal volume especially in V(1-3) and the cross-sectional area especially in the C-notch. Interestingly, the change in the C-notch decreased gradually with time. One possible mechanism may be the change in compliance between the skin under the Breathe Right and the nasal mucous membrane. The nasal cycle did not significantly influence the effect of Breathe Right.

[A statistical analysis of epistaxis between outpatients and inpatients].

Although we found several statistical studies on epistaxis, we found no reports discussing clinical differences in nasal bleeding between outpatients and inpatients. We therefore examined 103 inpatients (1998-2001) and 337 outpatients (2001) with epistaxis for gender, age, season, bleeding points, and blood pressure. We then compared these parameters statistically in both groups using Mann-Whitney's U test. The incidence of epistaxis in inpatients was statistically higher in winter than in any other season, and most had uncontrolled borderline hypertension. We concluded that borderline hypertension worsens in winter and that patients with borderline hypertension should be medicated to prevent severe epistaxis.

[Statistical study on the case of aural foreign bodies].

Although aural foreign bodies are very frequently seen in daily practice, few reports systematically analyze a large case population. We report 509 cases seen at our clinic during the 16 years from January 1986 to December 2001. All were clinically confirmed during the same period among a total of 68,579 new visitors and cases with aural foreign bodies accounted for 0.74%. Cases seen during routine outpatient clinic hours were 161 (31.6%), and others seen in emergencies were 348 (68.4%). Among these were 307 men (60.3%) and 202 women (39.7%). The right side involved 251 (49.3%), the left side 241 (47.3%), and bilateral 4 (0.8%). Monthly distribution showed an average of 42.4 cases a month, peaking during the months of July and August, when temperatures are highest. Age distribution showed an average of 25.4 years old, ranging from 1 month to 90 years of age. Those under 9 years numbered 182 (35.8%) and were the peak incidence by age. In classification by organic and inorganic, organic materials accounted for 206 (40.5%) and inorganic for 288 (56.6%). Organic materials appeared to be related to monthly distribution, i.e. more cases in hot months.

Caspase 3 activation in nasal capillary in patients with epistaxis.

OBJECTIVE: We investigated whether an apoptosis of nasal microvessels contributes to probable mechanism of the onset of epistaxis. STUDY DESIGN AND SETTING: Nasal septal mucosa of Little's areas taken from patients without (n = 19) and with (n = 26) epistaxis were examined. Active caspase-3 in the mucosa was detected according to the methods of immunohistochemistry and Western blotting. On Western blot analysis of the homogenates of the mucosa, we also sought probable signaling factors after caspase-3 activation. RESULTS: Marked activation of caspase-3 was detected in the capillaries and its neighboring muscle cells of Little's area from patients with epistaxis, and the activation was due to enhanced expression of procaspase-3 protein and progressive cleavage of the precursor. As a result of Western blotting of signaling factors, enhanced expressions of caspase-9 and Bax protein in the homogenates of Little's area in epistaxis group were found compared with those in control group. Increased levels of cytochrome c released into a cytosol were also detected in the capillaries in epistaxis group. CONCLUSION: In the present study, caspase-3 activation was found in the capillaries of Little's area from patients with epistaxis, suggesting that an apoptosis of capillaries may contribute to a mechanism of the onset of epistaxis. Moreover, alterations of some apoptotic factors such as caspase-9, Bax, and cytochrome c in the tissues demonstrated participation of mitochondrial disturbance in one of the apoptotic mechanisms. SIGNIFICANCE: Further explorations of the pathobiologic mechanism of capillary apoptosis can lead not only to an identification of risk factors in the onset of epistaxis but also to the development of medical therapy of epistaxis.