Acquired nasopharyngeal stenosis in a patient with sarcoidosis.

INTRODUCTION: Acquired nasopharyngeal stenosis typically occurs as a result of surgery or irradiation of the nasopharynx. Sarcoidosis has numerous manifestations in the head and neck region, although an association with nasopharyngeal stenosis has not previously been reported. CASE REPORT: A 40-year-old man with sarcoidosis developed severe acquired nasopharyngeal stenosis. This was successfully managed with balloon dilatation, followed by pharyngoplasty with local pharyngeal flap reconstruction. CONCLUSION: This report is intended to prompt consideration of nasopharyngeal stenosis as a potential cause of nasal obstruction in patients with sarcoidosis, and to draw attention to the need to consider sarcoidosis in the differential diagnosis of patients with acquired nasopharyngeal stenosis. We also demonstrate the viability of pharyngoplasty in the management of nasopharyngeal stenosis in the setting of sarcoidosis.

The Community Liaison Program: a health education pilot program to increase minority awareness of HIV and acceptance of HIV vaccine trials.

This paper describes a 16-month health education pilot program based on diffusion of innovation and social network theories. The program was implemented by volunteer community liaisons for the purposes of increasing awareness of and support for HIV vaccine research in minority populations. This theoretically driven pilot program allowed the liaisons to integrate delivery of the HIV vaccine research messages created for the program into their existing activities and routines. Through training in participatory engagement, volunteers were able to tailor and adapt an HIV prevention message for their communities. Process evaluation data showed that the acceptance of participatory engagement and HIV vaccine message dissemination far exceeded expectations. The anticipated number of community members to receive the message was estimated at 500 with 10 volunteer liaisons or 50 per person. However, the actual number of people reached was 644, with only 7 volunteer liaisons, or an average of 92 persons per liaison, almost double the original number. Further research is recommended to analyze the specific behavioral changes that can come from the use of social networks in HIV vaccine research awareness within minority populations.

Laryngeal and phonatory status after burn/inhalation injury: a long term follow-up study.

Although persistent hoarseness has been recognized in patients who have sustained burn and/or smoke inhalation injuries, there is little documentation to support this observation. Furthermore, there is no quantification of either the pervasiveness of the problem or the severity of the dysphonia resulting. It was the intent of this study to examine the laryngeal condition and voice production of a group of patients who were long-term survivors of burns and inhalation injuries. Only 10 patients (8 male and 2 female) of a larger cohort were willing to return for this examination. They were ambulatory and did not require respiratory assistance, and it had been 16 to 25 years since their initial traumas. Videostrobolaryngoscopic examinations were performed and analyzed, measures of various acoustic and aerodynamic parameters were made, and severity of dysphonia was judged. Seven of the 10 subjects were rated by experienced listeners as having some degree of dysphonia. All subjects had some abnormality of the laryngeal mucosa. Stroboscopic examination was found to be helpful in identifying laryngeal abnormalities in at least half of the subjects. Early attention to these problems, many of which are treatable surgically or behaviorally or both could lead to an improved voice for the patient and for this reason an improved quality of life.

Vocal intensity characteristics in normal and elderly speakers.

The relationship of lung pressure, fundamental frequency, peak airflow, open quotient, and maximal flow declination rate to vocal intensity for a normal speaking, young male control group and an elderly male group was investigated. The control group consisted of 17 healthy male subjects with a mean age of 30 years and the elderly group consisted of 11 healthy male subjects with a mean age of 77 years. Data were collected at three levels of vocal intensity: soft, comfortable, and loud, corresponding to 25%, 50%, and 75% of dynamic range, respectively. Phonational threshold pressure and lung pressure were obtained using the intraoral technique. The oral airflow waveform was inverse filtered to provide an approximation to the glottal airflow waveform from which measures of fundamental frequency, peak airflow, open quotient, and maximal flow declination rate were determined. Excess lung pressure was calculated as lung pressure minus estimated phonational threshold pressure. The results show for both groups an increase in sound pressure level across the conditions, with corresponding increases in lung pressure, excess lung pressure, fundamental frequency, peak airflow, and maximal flow declination rate. Open quotient decreased with increasing vocal intensity. Lung pressure, sound pressure level, and peak airflow were all found to be significantly greater for the control group than for the elderly group at each condition. Open quotient was found to be significantly lower in the control group than in the elderly group at each condition. No significant difference was observed for excess lung pressure, phonational threshold pressure, fundamental frequency, or maximal flow declination rate between the two groups. These results show that a difference in vocal intensity does exist between young and elderly voices and that this difference is the result of differences in lung pressure, peak airflow, and open quotient.

Transnasal endoscopic surgery of the pituitary gland: technical note.

OBJECTIVE: An approach to transnasal transsphenoidal debulking of pituitary tumors using endoscopic guidance is presented. METHODS: Technical details of this approach using an endoscope inserted through one nostril and operating instruments inserted through a submucosal tunnel created via the other nostril are discussed. RESULTS: Ten patients who had operations are tabulated. Illustrative cases are presented. CONCLUSION: Endoscopic debulking of pituitary tumors can provide good results with minimal operative morbidity.

Endothelial heparan sulfate proteoglycan. I. Inhibitory effects on smooth muscle cell proliferation.

Proliferation of smooth muscle cells is an important component of pulmonary arterial morphogenesis, both during normal development and pathologic remodeling. However, little is known of the factors that regulate smooth muscle proliferation in these vessels. To investigate the hypothesis that factors produced by endothelial cells may regulate smooth muscle cell growth, we studied the effects of culture medium conditioned by fetal bovine pulmonary arterial endothelium on proliferation of smooth muscle cells in culture. This conditioned medium contains an inhibitor of smooth muscle proliferation that is degraded by nitrous acid, heparinase, and heparitinase, but resists degradation by protease, boiling, and chondroitin ABC lyase, indicating that the inhibitor is structurally similar to heparin. Inhibitor release occurs in both growing and confluent endothelial cell cultures and in the presence and absence of serum. A growth-inhibiting proteoglycan purified to homogeneity from endothelial cell-conditioned medium has physicochemical characteristics similar to those of the prototypic basement membrane heparan sulfate proteoglycan of the Englebreth-Holm-Swarm tumor: an overall size of approximately 10(6) D, heparan sulfate chains of 60,000 D, and a buoyant density of 1.33 g/ml. Antibody raised against the tumor basement proteoglycan recognizes this endothelial heparan sulfate proteoglycan, and Western blotting after SDS-PAGE demonstrates that the core proteins of both proteoglycans migrate as a doublet at apparent molecular weights of 450,000 and 360,000 D. Heparan sulfate glycosaminoglycan prepared from purified medium proteoglycan is a potent inhibitor of smooth muscle cell growth, exhibiting activity approximately 1,000 times greater than that of heparin. These results indicate that endothelial cells cultured from fetal bovine pulmonary arteries produce a basement membrane heparan sulfate proteoglycan that is a potent inhibitor of smooth muscle proliferation. This proteoglycan may mediate endothelial regulation of smooth muscle growth during development or pathologic pulmonary arterial remodeling.

Mitochondrial function after acute alteration of the endogenous insulin-to-glucagon ratio.

Mannoheptulose (2g/kg i.p.) increases serum glucagon and decreases serum insulin via its effect on pancreatic islet cells. These changes in endogenous hormone status had effects on rat liver mitochondria that were comparable to the effects of injecting porcine glucagon (0.5 mg/kg i.p.). Mitochondrial adenine nucleotide content was increased 38 or 39% by mannoheptulose or glucagon respectively, citrulline synthesis by 165 or 193%, pyruvate carboxylation by 113 or 135%, coupled respiration by 34 or 42%, and uncoupled respiration by 40 or 54%. We conclude that the reciprocal changes in endogenous insulin and glucagon brought about by mannoheptulose offer a useful and interesting alternative to glucagon injection for studying the effects of these pancreatic hormones on liver mitochondria.