The evaluation of adenoid hypertrophy and obstruction grading based on rhinomanometry after nasal decongestant test in children.

OBJECTIVES: Adenoid hypertrophy (AH) is a very common problem in children. Nasal Fiberoptic Endoscopy (NFE) represents the gold standard method to diagnose AH. Rhinomanometry represents a valid diagnostic support. The aim of our study was to analyze the grade of nasal obstruction caused by AH, in a group of children, with rhinomanometry standard and after ND test versus NFE. PATIENTS AND METHODS: Two hundred and eighty-four of 300 collaborative children, diagnosed as chronic oral breathers, were enrolled. All children underwent a complete physical examination, anterior active rhinomanometry and a second rhinomanometry after the administration of the nasal decongestant (ND) xylometazoline. All children were evaluated using Nasal Fiberoptic Endoscopy (NFE). RESULTS: At rhinomanometry nasal obstrucion was found of grade 1 in 102 (35.9%) children, of grade 2 in 41 (14.4%), of grade 3 in 52 (18.3%), of grade 4 in 37 (13%) and of grade 5 in 52 (18.3%). Those patients were tested also with rhinomanometry after ND: grade 1 in 108 (38%) children, grade 2 in 52 (18.3%), grade 3 in 56 (19.7%), grade 4 in 23 (8.1%) and grade 5 in 45 (15.8%). At NFE: 83 (29.2%) patients presented a grade 0, 73 (28.7%) a grade 1, 51 (17.9%), 34 (11.9%) a grade 3 and 43 (15.1%) a grade 4. Comparing the grade of nasal obstruction in NFE and in RM after ND we found a great correlation for grade 1 and grade 5 (respectively 84.3% and 79,1%, p < 0.001) and low correlation for the others grades of obstruction. When compared to NFE, rhinomanometry test after ND had 81.1% sensitivity and 84.3% specificity. Operating Characteristic (ROC) curves were derived using data related to rhinomanometry vs NFE, and to Rhinomanometry after ND vs NFE. CONCLUSIONS: Rhinomanometry after ND, compared to rmhinomanometry, is more specific and useful to evaluate nasal obstruction due to AH in children. RM after ND is a great tool to assess the severity of nasal obstruction. In fact, the minimum and maximum degrees of obstruction to the RM after ND correlate significantly (p < 0.01) with those of NFE.

Innovations in the Use of Interactive Technology to Support Weight Management.

New and emerging mobile technologies are providing unprecedented possibilities for understanding and intervening on obesity-related behaviors in real time. However, the mobile health (mHealth) field has yet to catch up with the fast-paced development of technology. Current mHealth efforts in weight management still tend to focus mainly on short message systems (SMS) interventions, rather than taking advantage of real-time sensing to develop just-in-time adaptive interventions (JITAIs). This paper will give an overview of the current technology landscape for sensing and intervening on three behaviors that are central to weight management: diet, physical activity, and sleep. Then five studies that really dig into the possibilities that these new technologies afford will be showcased. We conclude with a discussion of hurdles that mHealth obesity research has yet to overcome and a future-facing discussion.

Recombinant interleukin-2 continuous infusion in ovarian cancer patients with minimal residual disease at second-look.

Recent reports suggest that recombinant interleukin-2 may be effective in the treatment of cancer patients with low tumor burden. Considering the poor long-term survival, 11 ovarian cancer patients with minimal residual disease at second-look have so far been selected for rIL-2 intravenous continuous infusion therapy: two induction courses (3 x 10(6) U/m2/day: 120 h + 108 h) followed by three maintenance courses (3 x 10(6) U/m2/day: 120 h) and third-look laparotomy. At present, three patients are still on treatment, three have completed it, and five have discontinued treatment. Sixty-seven per cent of the planned dose was administered in 49 cycles of which 42 (86%) required dose modifications due to hypotension (greater than or equal to grade III) and nephrotoxicity (greater than grade I). CNS and GI toxicity, allergies and fever, even though requiring dose modifications in a few cases, significantly affected patient compliance. The rebound lymphocytosis was clearly dose-related and a significant percentage increase after rIL-2 was detected only for IL-2 receptor positive cells. To date, four patients are evaluable for response after a median follow-up of 7 months, two progressed during the maintenance period, while one CR and one progression were detected in the two patients so far submitted to third-look laparotomy.

Scanning electron microscopy of rabbit tubes at different intervals after anastomosis using fibrin glue.

Eighteen New Zealand White rabbits were submitted to tubal anastomosis using fibrin glue. The animals were then killed at different intervals (2-56 days) and the tubes were removed for analysis with the scanning electron microscope in order to study re-epithelialization and ciliogenesis. For the first 4 days after the operation the epithelium seemed to suffer considerable traumatic effects and was de-epithelialized. On the 6th day cells with microvilli appeared and towards the 10th day the first cilia were seen. Ciliogenesis was complete between 2 and 4 weeks after the operation, at which time the cilia re-acquired the ability to beat in coordination, as well as attaining normal quantity and length. The time required for recovery by the epithelium after anastomosis with fibrin glue would thus seem similar to that required when other suture materials are used. Fibrin glue thus combines the advantage of a considerable reduction in operating times with the ability to be rapidly reabsorbed, with complete restitutio ad integrum of the tissues.

Fibrin glue vs. nylon in the anastomosis of rabbit fallopian tubes.

Fibrin glue was used in end-to-end tubal anastomosis on eight sexually mature female New Zealand white rabbits. The right fallopian tubes were anastomosed with 10/0 nylon and the left with fibrin glue (Tissucol). The animals were mated with males of proven fertility six weeks after surgery and killed two weeks later. The gestational sacs and corpora lutea on the right and left sides were counted separately and the nidation index calculated for each. The presence of adhesions was also evaluated. All the tubes were finally examined under a scanning electron microscope. The fibrin glue was satisfactory in terms of patency, pregnancy and morphology of the epithelium.

The role of rhinomanometry after nasal decongestant test in the assessment of adenoid hypertrophy in children.

INTRODUCTION: Nasal respiratory obstruction is a very common otolaryngologic problem, often caused by adenoid hypertrophy (AH). Nasal fiberoptic endoscopy (NFE) represents the gold standard method to diagnose AH. Rhinomanometry represents a valid diagnostic support. OBJECTIVE: The aim of our study was to analyze the diagnostic value of rhinomanometry after nasal decongestant (ND) test for the evaluation of adenoid hypertrophy in children. MATERIALS AND METHODS: Seventy-one of 97 collaborative children, aged 6-12 years, affected by upper airways obstructive symptoms and diagnosed as 'chronic oral breathers' by a standardized questionnaire were included in the study. The first evaluation included a complete physical examination, anterior rhinoscopy and anterior active rhinomanometry. Patients with a positive rhinomanometry underwent a second rhinomanometry after the administration of the nasal decongestant (ND) xylometazoline. All children were evaluated using nasal fiberoptic endoscopy (NFE). RESULTS: At rhinomanometry a normal nasal airflow was found in 19 (26.8%) of children while nasal obstruction was underlined in 52 (73.2%). These patients were tested also with rhinomanometry after ND which confirmed the presence of nasal obstruction in 29 (55.7%) of patients. All patients included in the study underwent a NFE: 34 (47.8%) of them presented severe AH with an occlusion >75% of the choanal opening (grade ≥ 3) and 37 (52.2%) presented no or a mild form of AH (grade < 3). When compared to NFE, rhinomanometry test after ND had 82.7% sensitivity and 82.6% specificity. Positive predictive value and negative predictive value were 85.7% and 79.2%, respectively. Two receiver operating characteristic (ROC) curves were derived using data related to rhinomanometry vs NFE, and to rhinomanometry after ND vs NFE. CONCLUSIONS: Rhinomanometry after ND, compared to rhinomanometry, is more specific and useful to evaluate nasal obstruction due to AH in children, and it may be helpful to avoid unnecessary surgical procedures in children with temporary nasal obstruction.

Secondary syphilis. Clinical morphology and histopathology.

Twenty-four biopsy specimens of skin were taken from 23 patients with several types of lesions of secondary syphilis. In macular and maculopapular lesions, the histological changes were not specific. No or few plasma cells were observed in specimens at this stage. In early papular lesions, the histological appearance was more diagnostic. A lymphohistiocytic bandlike infiltrate was present in the upper part of the dermis and extended around blood vessels of the deep plexus. In nearly two-thirds of the cases, plasma cells were present in early papular lesions. The epidermis, too, was frequently involved in these lesions of the disease. In late papular lesions, the pathologic features were distinctive. The infiltrate was dense, diffuse, and, in some instances, nearly completely plasmocytic. In nummular syphilides, many neutrophils were present in a hyperplastic epidermis, whereas in corymbiform lesions, the epidermis was not involved at all.

Polydioxanone in anastomosis of rabbit tubes. A morphological study of the epithelium.

Eight NZW rabbits were submitted to end-to-end tubal anastomosis using polydioxanone (PDS), (Ethicon). The animals were sacrificed at two-week intervals between the second and sixteenth week after operating. The tubes were removed and analysed with the scanning electron microscope for the purpose of studying the morphology of the epithelium. Ciliogenesis was completed between the second and fourth weeks. After this period the epithelial conditions observed were completely normal, except for an abundant mucous secretion which, however, was totally normal after sixteen weeks.

Pharmacological prevention of postoperative adhesions experimentally induced in the rat.

In order to evaluate the preventive action of certain drugs in the formation of adhesions, three different types of trauma were induced in the uterine horns of 105 female Wistar rats. The animals were divided into six groups of 15 rats each and to each group was administered respectively: aprotinin i.p.; hydrocortisone i.p.; dextran 70 i.p.; colchicine i.p.; saline i.p.; colchicine i.m. One more group of 15 rats was left without treatment, as control. Four weeks later the adhesions were evaluated according to a qualitative/quantitative score and the results analysed using advanced statistical analysis. Aprotinin achieved the best results both in and around the trauma areas. Dextran produced an overall reduction of adhesions, but showed no specific effect on the trauma areas. The other substances failed to improve the adhesion situation.

Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids.

OBJECTIVE: To compare laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH) in patients with uterine fibroids. DESIGN: A prospective randomised study. SETTING: The San Paolo Hospital, Milan. POPULATION: Sixty-two patients, who were not suitable for a vaginal hysterectomy, requiring treatment for uterine fibroids. METHODS: Randomisation between LAVH and TAH. Comparison of outcomes on the whole series, patients with uteri < or = 500 g (Group 1) and patients with uteri > 500 g (Group 2). MAIN OUTCOME MEASURES: To establish operating time, blood loss, complications, febrile morbidity, analgesics administration and hospital stay for both treatment approaches. RESULTS: Median uterine weight was 400 g in both LAVH and TAH group. Median operating time was longer for LAVH (135 min compared with 120 min for TAH; P = 0.001), but patients undergoing LAVH had less analgesics administration (23% compared with 77%, P < 0.001) and a shorter median hospital stay (3.8 compared with 5.8 days; P < 0.001). LAVH, when compared with TAH in the two weight subgroups, required a significantly longer operating time only in Group 2, significantly reduced analgesics administration only in Group 1, and significantly reduced hospital stay in both groups. Conversions of LAVH to laparotomy were significantly more frequent in Group 2 (3/11) than in Group 1 (0/20) (P = 0.04). CONCLUSIONS: Compared with TAH, LAVH has advantages in removing uteri weighing < or = 500 g, with comparable operating time, less post-operative pain and shorter recovery. Among uteri weighing > 500 g LAVH showed a shorter recovery, but longer operating time than TAH and a 27% rate of conversion to laparotomy.

Color-Doppler velocimetry of uterine arteries in pregnant and nonpregnant patients during multiovulation induction for IVF.

OBJECTIVES: To evaluate uterine artery resistance during multiovulation induction in relation to the implantation rate in patients attending in vitro fertilization (IVF) cycles. PATIENTS: Multiovulation induction for IVF was monitored by daily determination of the pulsatility index (PI) of the uterine arteries, obtained by a transvaginal probe (6.5 MHz) implemented with color-flow imaging. Doppler data were obtained from 5 days before hCG administration to the day of follicular aspiration. One IVF cycle was monitored in 70 patients. In 17 patients, 41 IVF cycles were monitored until a successful attempt occurred. RESULTS: In the 70 patients studied during one IVF attempt, the PI of the uterine arteries significantly varied (P < 0.001) in the different phases of the cycle. In the 24 patients who conceived, a significantly lower PI (P < 0.03) was found throughout the cycle. This result was mainly due to a highly significant difference of PI values observed the day after hCG administration (P < 0.005). In the 17 patients who conceived after 1 to 4 negative in vitro fertilizations, no significant difference in PI was observed in the uterine artery resistance in cycles in which implantation was or was not successful. CONCLUSIONS: Uterine artery resistance varies significantly during phases of the induction therapy. Uterine artery resistance is lower throughout the course of multiovulation induction in patients with higher pregnancy rates. The PI on the day after hCG administration was the best index of pregnancy rate. Low uterine artery resistance was present even in negative attempts in patients who eventually achieved a successful implantation. PI values < or = 3 can be considered a favorable prognostic factor for future IVF cycles.

High-dose cisplatin and bleomycin neoadjuvant chemotherapy plus radical surgery in locally advanced cervical carcinoma: a preliminary report.

One course of chemotherapy containing cisplatin and bleomycin as a neoadjuvant treatment was given to 26 consecutive patients with previously untreated stage IB (bulky disease)-III cervical carcinoma and followed by radical surgery. After chemotherapy responses were detected in 23 patients (5 complete and 18 partial; overall, 88%) and permitted radical surgery in 21 cases (81%). Surgery consisted of type III-IV radical hysterectomy plus systematic para-aortic and pelvic lymphadenectomy. At histologic examination, complete responses were found in 5 (19%) and partial responses in 16 (62%) cases. The average number of lymph nodes removed was 61 (range, 38-118). A lower than expected incidence of lymph node metastases was detected (2/21, 9.5%). The chemotherapy-induced toxicity was mainly represented by nausea and vomiting. Chemotherapy did not seem to complicate surgery in these circumstances, even though moderate-degree postoperative complications occurred in 48% of cases. Eighteen months median follow-up time (range, 11-23) from hystological diagnosis has been reached in the operated patients, and no recurrences have been detected so far.

Neoadjuvant chemotherapy and radical surgery in locally advanced cervical cancer. Prognostic factors for response and survival.

Between January 1986 and September 1988, 75 patients with locally advanced cervical carcinoma (International Federation of Gynecology and Obstetrics [FIGO] Stages IB-III) received three courses of neoadjuvant chemotherapy (NAC), including cisplatin, bleomycin, and methotrexate (PBM). Fifteen percent of patients achieved a complete response (CR) and 68% a partial response (PR). Pretreatment characteristics were analyzed for response to NAC. Significantly lower response rates were found in patients with tumor size more than 5 cm in diameter and bilateral parametrial involvement to the pelvic side wall. None of the biological parameters studied was related to chemoresponsiveness. Patients achieving CR or PR had a significantly improved 3-year survival rate compared with those who did not respond. After NAC, radical surgery was possible in all responding patients. The median number of lymph nodes removed was 60. A lower than expected incidence of lymph node metastases was detected. None of the clinical and pathologic features considered was significantly correlated with the lymph node status. Twelve of the 62 operated patients had disease recurrence. Pathologic parametrial involvement and cervical infiltration equal to or deeper than 5 mm were found to be significant prognostic factors for recurrence. A 3-year, disease-free survival of 89%, 73%, and 43% for Stage IB-IIA, IIB, and III, respectively, was found. Among the operated patients these rates increased to 100%, 81%, and 66% for Stage IB-IIA, IIB, and III, respectively. A prospective randomized trial comparing NAC and surgery with radiotherapy alone is in progress.

Rationale for very high-dose chemotherapy with peripheral blood stem cell support in advanced ovarian cancer.

Although significant progress has been made in the management of advanced ovarian cancer, the majority of patients continue to die of this disease. Most advanced ovarian cancer patients present sub-optimal residual tumour after primary surgery and their prognosis is very poor since residual disease has been confirmed as the major factor predicting response to chemotherapy and survival. Therefore, it seems worth developing treatment modalities that can produce a longer remission period. In this short review, the authors summarize the clinical and experimental evidence supporting the usefulness of high-dose chemotherapy with autologous peripheral blood stem cell transplantation in advanced ovarian cancer.