Current trends in rhinoplasty and the nasal airway.

The current trends in rhinoplasty and the nasal airway are discussed. The rhinoplastic ideal is that which is aesthetically pleasing while maintaining or improving the physiologic functions of the nose. It is important for the primary care physician to understand the different aspects of rhinoplasty so that he or she may determine which patients will have success with this surgery. Furthermore, the primary care physician will have a better understanding of what the surgeon tries to achieve with rhinoplasty surgery.

Chronic sinusitis: an update.

An accurate history is essential to the diagnosis of chronic sinusitis. Patients classically present with several weeks of daily facial pain or pressure between the eyes, headache, nasal congestion, postnasal drip, ear pain or blockage, and fatigue. The headache in chronic sinusitis is usually worse in the morning and following head movement. Purulent nasal discharge, spiking fever, an elevated white blood cell count, and intense, brief headache associated with nausea and vomiting are uncommon. Palpation, transillumination of the sinuses and anterior rhinoscopy are of minimal value in making the diagnosis. Fiberoptic nasopharyngoscopy can be used to identify the source of sinus discharge and the cause of obstruction. Although plain sinus radiographs are useful in diagnosing and monitoring acute sinusitis, they are of limited value in confirming chronic sinusitis. The sinuses are better imaged with computed tomographic scanning. Prolonged antibiotic therapy, in combination with decongestants and steroids, is usually effective for chronic sinusitis. In recalcitrant cases, sinus surgery may be necessary.

Effect of uvulopalatopharyngoplasty on upper airway collapsibility in obstructive sleep apnea.

Previous investigators have demonstrated variable responses to uvulopalatopharyngoplasty (UPP) in patients with obstructive sleep apnea. We hypothesized that this variability is due to either (1) differences in baseline pharyngeal collapsibility preoperatively or (2) differences in magnitude of the decrease in pharyngeal collapsibility resulting from surgery. To determine the relationship between changes in collapsibility and the response to UPP surgery, we measured the upper airway critical pressure (Pcrit) before and after UPP in 13 patients with obstructive sleep apnea. During non-REM sleep, maximal inspiratory airflow (VImax) was quantitated by varying the level of nasal pressure (PN), and Pcrit was determined by the level of PN below which VImax ceased. A positive response to UPP was defined by a greater than or equal to 50% fall in non-REM disordered breathing rate (DBR). In the entire group, UPP resulted in significant decreases in DBR from 71.1 +/- 22.4 to 44.7 +/- 38.4 episodes/h (p = 0.025) and in Pcrit from 0.2 +/- 2.4 to -3.1 +/- 5.4 cm H2O (p = 0.016). Moreover, the percent change in DBR was correlated significantly with the change in Pcrit (p = 0.001). Subgroup analysis of responders and nonresponders demonstrated that significant differences in Pcrit were confined to the responders. Specifically, responders demonstrated a significant fall in Pcrit from -0.8 +/- 3.0 to -7.3 +/- 4.9 cm H2O (p = 0.01), whereas no significant change in Pcrit was detected in the nonresponders (1.1 +/- 1.6 versus 0.6 +/- 2.0 cm H2O. No clinical, polysomnographic, or physiologic predictors of a favorable response were found preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Cancer mortality among a representative sample of nonsmokers in the United States during 1966--68.

Data are presented on cancer and total mortality among a representative sample of nonsmokers and the total population 35--84 years of age in the United States during 1966--68 that measured the influence of cigarette smoking on mortality rates, independent of other health-related factors. Of all U.S. white males, those who never smoked cigarettes have a total age-adjusted cancer death rate which is 37% less than that of males as a whole and 53% less than that of those who currently smoke cigarettes. Correspondingly, of all U.S. white females, those who never smoked cigarettes have a total age-adjusted cancer death rate which is 15% less than females as a whole and 33% less than that of those who currently smoke cigarettes. The largest cancer rate reduction in the nonsmokers is concentrated in the respiratory system. Nonsmokers have an age-adjusted total death rate which is about 20% less than the population as a whole and about 43% less than current cigarette smokers. These and other results and methodologic issues are discussed.