Effectiveness of chondrofascial 'cigar' graft in contouring the nasal dorsum.

Irregularities of the nasal dorsum after rhinoplasty are frustrating for the patient and the surgeon. Different grafts and implants have been adopted to camouflage this nasal imperfection. This study was performed to assess the outcome of a composite chondrofascial 'cigar' graft for contouring an irregular nasal dorsum. Thirty-six patients who underwent rhinoplasty between May 2014 and October 2016 were studied prospectively. The cartilaginous core of the graft was obtained from the septal or conchal cartilage, while the graft outer sleeve was harvested from the right lateral thigh fascia lata. The graft was secured over the nasal dorsum through an external rhinoplasty approach. The patients were followed up for at least 18 months postoperative. All participants were evaluated objectively by two independent rhinoplasty surgeons and subjectively by Rhinoplasty Outcome Evaluation (ROE) score. Donor site morbidity was also assessed. All patients had satisfactory aesthetic results with no apparent irregularities detected over the nasal dorsum. The ROE score improved, from a mean of 20.94±8.67 (range 8-58) preoperatively to a mean of 79.56±10.65 (range 50-96) postoperatively. Insignificant donor site morbidity was encountered, with inconsequential effects. The chondrofascial cigar graft is a reliable method for contouring dorsal irregularities, particularly in patients with thin nasal skin.

Stentless mirrored L-shaped septonasal flap versus stented flapless technique for endoscopic endonasal repair of bilateral congenital choanal atresia: a prospective randomised controlled study.

OBJECTIVES: To compare the outcomes of endoscopic repair of bilateral congenital choanal atresia using a flap technique without stenting versus endoscopic repair using stenting without a flap. METHODS: A prospective randomised controlled study was conducted, comprising 72 patients with bilateral congenital choanal atresia. The patients were randomised into two groups. Group A (42 patients) underwent endoscopic repair using a mirrored L-shaped flap without stenting, and group B (30 patients) underwent endoscopic repair using stenting without a flap. RESULTS: At a mean follow-up period of 18.2 months, endoscopic assessment revealed a patent posterior choana in 81 per cent and 83.33 per cent of patients in group A and group B respectively. Choanal stenosis occurred in 21.40 per cent and 33.33 per cent of patients in group A and group B respectively. Granulation tissue was observed in 28.6 per cent and 53.3 per cent of patients in group A and group B respectively. CONCLUSION: The endoscopic approach utilising a flap without stenting is safe and effective, with a high success rate.

Endoscope affects decision making in cholesteatoma surgery.

OBJECTIVE: The aim of the present study was to evaluate the use of intraoperative otoendoscopy as a factor that could influence surgical decision-making in cholesteatoma surgery. MATERIALS AND METHODS: The material of this study included 82 ears with acquired cholesteatoma that were operated on. They were divided into 4 groups according to the surgical technique chosen and the use of the endoscope. Group I included 22 ears that underwent canal wall-down (CWD) tympanomastoid surgery, group II included 20 ears that underwent CWD tympanomastoid surgery with intraoperative use of endoscopy, group III included 20 ears that underwent canal wall-up (CWU) tympanomastoid surgery, and group IV included 20 ears that underwent CWU tympanomastoid surgery with intraoperative use of endoscopy. Endoscopy was used as a complementary tool to microscopy. The follow-up period ranged from 12 to 48 months. RESULTS: Intraoperative remnants of cholesteatoma matrix were detected during both CWU and CWD by the use of the rigid endoscope. However, its incidence was higher in the CWU group (50%) than in the CWD (30%) group. Most of these remnants were in the sinus tympani (37.5%). The mean duration of follow-up was 18.19 (+/-8.7) months. Postoperative residual cholesteatoma was much higher in the CWU group (25%) than in the CWD group (5%). All residuals were from groups of patients in whom intraoperative endoscopy was not used in the primary surgery. CONCLUSION: Our results showed that the use of the endoscope gave the surgeon better control over the pathology, thus achieving better eradication. Stated differently, the use of the endoscope raised the surgeon's confidence level about total removal and thus encouraged the surgeon to keep the canal wall intact while removing cholesteatoma in hidden areas. Therefore, the use of endoscope could be considered an additional tool that may affect decision-making in cholesteatoma surgery.

Broncho-alveolar lavage in chronic upper respiratory tract infections.

The relationship between upper and lower respiratory tract infections has been demonstrated previously, although the effect of chronic infection of one tract on the other has not been well studied. This work analyses the broncho-alveolar lavage fluid of patients with chronic purulent rhino-sinusitis and reveals an increase in total and neutrophil cell counts as well as an increase in immuno-globulin A levels. The associated increase in the neutrophil nitro-blue tetrazolium dye reduction test positivity provides evidence for increased phagocytosis to compensate for the increased contamination of the lower respiratory tract.

Pharmacokinetics of praziquantel in healthy volunteers and patients with schistosomiasis.

The pharmacokinetics of a novel praziquantel preparation (Distocide) were investigated in Sudanese patients with hepatosplenic schistosomiasis and in healthy volunteers, and compared with those of Biltricide. The results of the first study indicated greater (P less than 0.05) plasma concentrations of Biltricide at 1.5, 2, 3 and 5 h after administration than with Distocide; plasma elimination half-lives (t 1/2) were not significantly different. In patients with hepatosplenic schistosomiasis, higher plasma levels of Distocide were noted (P less than 0.05 at 8 h) compared to healthy controls; however, due to wide inter-individual variations, there were no significant differences in maximum plasma concentration, time to maximum plasma concentration, area under the plasma concentration curve (AUC), volume of distribution, or clearance; t 1/2 was greater (P less than 0.05) in patients (11.9 +/- 5.4 h) than controls (2.3 +/- 0.4 h). In the presence of food, higher plasma concentrations of Distocide occurred compared to the fasting state; AUCs were greater (P less than 0.01) in both food groups, although the values of t 1/2 were shorter. The lower plasma levels and longer duration of action of Distocide may be advantageous in reducing side effects and prolonging exposure of the schistosomes to the drug.

Characteristic functions of point monodirectional electron beams.

Narrow electron beams with approximately Gaussian radial fluence distributions were extracted from a clinical 42 MeV betatron by means of a special multi-diaphragm lead collimator with either 3 or 7.5 mm diameter of the effective diaphragm. From each narrow beam the dose distribution in water, was measured with an automated scanning system, and the corresponding dose distribution of the point monodirectional source was obtained by deconvolution. As a reference, the fluence distribution in air at the same distance z was used, corrected for multiple scattering in air where necessary. At 10, 20 and 40 MeV, non-linear pear-shaped curves for the root mean square radial excursion, sigma(z), as functions of the depth, with maxima of 12, 19.7 and 27.8 mm at about 70 per cent of the practical range were obtained. The second characteristic function, I(z), the integral of the dose over the transverse plane at depth z, was obtained from the measured broad beam depth dose curve and the associated transverse dose distributions.

Rhinitis medicamentosa: electron microscopic study.

The deleterious effect of decongestant drops on the rabbit respiratory nasal mucosa was studied with the aid of the electron microscope. The cilia were severely damaged, with the appearance of virus-like particles. The epithelium showed characteristic morphological details suggestive of oedematous infiltration. The tunical blood vessels revealed ultrastructural changes of their endothelial lining and basal lamina indicative of increased permeability.

Urbach-Wiethe disease in O.R.L. practice. (A clinical and histochemical study of the laryngeal lesions).

Urbach-Wiethe disease is a rare disorder, inherited in an autosomal recessive fashion. In this work we have studied the clinical data in six patients with well-established UWD. The histopathological and histochemical findings are discussed. Unless the otolaryngologist has a knowledge of the disease, the diagnosis can be missed.

The ceruminous glands in chronic suppurative otitis media. A histological and histochemical study.

The ceruminous glands have been studied histologically and histochemically in twenty patients suffering from chronic suppurative otitis media with discharging ears, and in ten patients with dry central perforations, in comparison with normal ears. The present study revealed hyperactivity of the glands initially; later on, atrophy and fibrosis took place. Thus the diminution of wax may be due to: (1) The washing effect of the discharge. (2) Atrophy of the glandular structures. (3) Periglandular fibrosis. As the discharge stops, regeneration of the glands occurs.

Changes in the lower respiratory epithelia induced by oestrogen intake. An experimental histopathological study.

Fifty-eight male and non-pregnant female guinea pigs with an average weight of 400 gm were used in this work, ten animals as a control group, the remaineder receiving oestrogen in the form of ethanyl oestradiol in a dose of 10 microgram/animal/day. Histopathological studies were carried out after periods of one, two, three, four and eight weeks, and three, six and twelve months respectively. The respiratory mucosa, at the different levels mentioned, showed definite changes. The surface epithelium showed metaplastic changes with mitotic figures, until complete and definite stratifications were reached. The cilia decreased and then disappeared completely, while the mucus-secreting goblet cells showed an initial augmentation in number and increased activity, followed by a gradual decrease in their number, until total disappearance occurred at the stage of stratification in the surface epithelium.

Chronic non-allergic hypertrophic rhinitis. A histochemical study.

The enzymatic changes in chronic hypertrophic rhinitis were studied in 14 patients. The cholinesterase content was increased in the subepithelium and stroma, denoting parasympathetic hyperactivity. Acid phosphatase was increased in the epithelium, subepithelium and around the glands, indicating increased shedding and phagocytic activity. Succinic dehydrogenase, alkaline phosphatase and alpha-esterase were increased in the mucous glands, denoting increase secretory activity, hence increased natural defence mechanism of the nasal mucosa.

Electron microscopic study of previously irradiated scleroma.

Nasal biopsies from 2 scleroma patients who had received previous X-ray therapy were investigated under the electron microscope. In the lamina propria, the majority of Mikulicz cells contained numerous small vacuoles. This was attributed to the effect of X-ray therapy causing temporary suppression of the inflammatory process followed by new granuloma formation. The vacuoles of the Mikulicz cells contained some fine granular and fibrillar material of unknown origin. Rounded electron-dense bodies with microprojections on their surface were present near some Mikulicz cells. These structures were considered to be Russell bodies. Occasional small lymph vessels with obstructed lumina were seen. This might indicate the rare spread of Klebsiella rhinoscleromatis bacilli to regional lymph nodes.

[Effects of neurectomy of the tympanic plexus on secretion of the parotid gland in man. Histopathological, histochemical and clinical study (author's transl)]. / Effets de la neurectomie du plexus tympanique sur la sécrétion de la glande parotide chez l'homme.

This study involved five patients suffering from bilateral chronic parotiditis and then with a persistent unilateral fistula of the parotid gland. Two types of parotid biopsy were examined: the first taken during surgery and the second six months later. All of the specimens underwent histopathological and histochemical investigations. Definitive degeneration and atrophic type changes were seen in all the parotid fragments removed six months after selective neurectomy of the tympanic plexus. Six months after surgery, all of the patients were cured.

[Calculation of the dose distribution of high-energy electrons within and behind tissue inhomogeneities of any width. II. Influence of multiple scattering (author's transl)]. / Berechnung der Dosisverteilung schneller Elektronen in und hinter Gewebeinhomogenitäten beliebiger Breite. II. Einfluss der Vielfachstreuung.

The algorithn proposed in 1976 to allow for the influences of tissue inhomogeneities in electron beam dose distributions has been improved. A factor adopted from Sternheimer corrects for differences in lateral displacement by multiple scattering within the inhomogeneity resp. the equivalent layer of the homogeneous medium. The algorithm has been tested by direct comparison with Monte Carlo computations for the example of cylindrical cavities in carbon at Eo=10 MeV and resulted in a very close approximation.

Systematic optimization of the double-scatterer system for electron beam field-flattening.

The scattering foil widely used for field flattening in electron therapy produces a distortion of the electron spectrum which significantly reduces the slope of the descending part of the depth dose curve. It is already known that this effect can be drastically reduced by replacing the scattering foil by a two-foil scatterer. The second foil, fit with a radial thickness profile, acts as a compensator, attenuating the central part and enhancing the peripheral part of the beam by electron scattering. Calculations of the optimal foil combinations and radial thickness profiles are presented and numerical values of smooth (Gaussian) and three-step profiles for various field sizes are provided. The results are applicable to a variety of electron energies and scattering foil materials.

Effect of tympanic neurectomy on human parotid salivary gland. Histopathologic, Histochemical, and Clinical Study.

Five patients with bilateral chronic recurrent parotiditis and ten patients with unilateral persistent paratoid gland fistulas underwent tympanic neurectomies. Two biopsy specimens from the diseased gland were examined. The first biopsy specimen was taken at the time of operation, while the second one was taken six months later. All specimens were subjected to both histopathologic and histochemical investigations. Definite degenerative and atrophic changes occured in all parotid gland specimens taken six months after selective tympanic neurectomy. All patients were completely cured at about that time. This supported the practical indication of the selective tympanic neurectomy for treating certain benign disorders or diseases of the parotid gland that require persistent arrest of the function of its secretory units.