Nasopharyngeal versus hypopharyngeal packing during sino-nasal surgeries: Randomised controlled trial.

OBJECTIVES: Primary: To compare the severity of postoperative throat pain between patients who received a nasopharyngeal pack and those who received a hypopharyngeal pack during their sino-nasal surgery. Secondary: To assess the efficacy of using a nasopharyngeal pack in preventing postoperative nausea and vomiting (PONV) and to compare its result with patients who received a hypopharyngeal pack. DESIGN: Prospective, randomised, controlled trial. SETTING: Tertiary Hospital. PARTICIPANTS: Forty-seven patients were evaluated. Eligible patients were randomly allocated into one of the two following groups: Group (A): hypopharyngeal packing during the surgery, or Group (B): nasopharyngeal packing during the surgery. MAIN OUTCOME MEASURES: The blinded Patients from both groups were evaluated at 2 hours, 24 hours and 1 week after the surgery by a blinded assessor. Throat pain was assessed using the standardised numeric rating scale for pain from zero to ten. The presence of PONV, oedema, congestion and ulceration of the pharyngeal mucosa was recorded. RESULTS: At 2 hours after the surgery, the median pain score for the nasopharyngeal group was less than the hypopharyngeal group (3.5 and 4.0, respectively), but this difference was not statistically significant (P = .195). Patients in both groups had the same median score (4.0) when throat pain was assessed 24 hours after surgery. The hypopharyngeal packing group has a lower incidence of PONV at 2 hours, 24 hours and 1 week, these differences were not statistically significant (P > .050). Pharyngeal ulceration was found in one patient from the hypopharyngeal group during the second assessment at 24 hours. No differences in the assessed pharyngeal physical signs were statistically significant at any of the assessment time points. CONCLUSION: The location of the throat pack does not affect the early postoperative throat pain. The nasopharyngeal pack is a safe alternative for the hypopharyngeal pack if throat packing is indicated. There is a need for review of the available current evidence on throat packs and more adequately powered randomised controlled trials on a larger scale of participants.

Chondroprotective effects of high-molecular-weight cross-linked hyaluronic acid in a rabbit knee osteoarthritis model.

OBJECTIVES: We hypothesized that high-molecular-weight (MW) cross-linked (CL) hyaluronic acid (HA) improves joint lubrication and has an enhanced chondroprotective effect. We examined the histopathological changes and friction coefficients in osteoarthritic knee joints after injecting high-MW CL HA. DESIGN: A bilateral anterior cruciate ligament transection (ACLT) model in 20 Japanese white rabbits was used. From week 5 after transection, low-MW HA (0.8 × 10(6) Da; HA80) or high-MW CL HA (6 × 10(6) Da; HA600) was injected weekly into 10 right knee for 3 weeks; normal saline (NS) was injected into the 10 left knee. A sham operation was undertaken to exclude spontaneous osteoarthritis (OA) in five knees. Results were evaluated with macroscopy, histopathology (Kikuchi's score), biomechanical testing, and rheological assessment of the joint fluid viscoelasticity. Statistical analysis was performed using one-way analysis of variance with a 95% confidence interval (CI) (P < 0.05). RESULTS: The macroscopic findings showed severely damaged cartilage in 30% of the NS group and 20% of the HA80 and HA600 groups and intact cartilage in 100% of the sham group. The histological scores and friction coefficients of the HA600 group were significantly lower than those of the NS group (P = 0.007 and P = 0.002, respectively). Viscoelasticity measurements of the joint fluid showed no significant differences between the three treatment groups. CONCLUSION: High-MW CL HA exerts potential chondroprotective effects and produces superior friction coefficients. Our results suggest that HA600 delays the progression of OA effectively and improves joint lubrication significantly.

Predictive Value of the Pattern of ß-Catenin Expression for Pathological Response to Neoadjuvant Chemotherapy in Breast Cancer Patients.

PURPOSE: This study aimed to explore the association of ß-catenin expression pattern with pathological response after neoadjuvant chemotherapy in breast cancer (BC) patients. MATERIALS AND METHODS: In this retrospective exploratory study, data for 50 BC patients who received neoadjuvant chemotherapy were recorded. ß-catenin expression in tumours was assessed using immunohistochemistry and classified as either membranous or cytoplasmic according to the pattern of staining. Distributions of different clinico-pathological parameters according to ß-catenin expression were assessed using the Chi-square test. Logistic regression analysis was used to assess any relation of the pattern of ß-catenin expression with the pathological response. RESULTS: Cytoplasmic ß-catenin expression was detected in 34% of BCs. Among our cases, 52% were hormonal receptor (HR)-positive, 24% were HER2-positive, 74% were clinical stage III and 74% received both anthracycline and taxane-based chemotherapy. Patients with cytoplasmic expression were more commonly younger than 40 years at diagnosis (cytoplasmic, 41.2% vs. no cytoplasmic expression, 12.1%, p=0.03). By doing t-test, cytoplasmic ß-catenin expression was linked with a higher body mass index compared to membranous-only expression (mean± SD 33.0 ± 4.47 vs. 29.6 ±6.01, respectively, p=0.046). No significant associations were found between ß-catenin expression and other parameters such as HR and HER2 status, or clinical stage. Complete pathological response (pCR) rate was twice as great in patients with membranous expression but without statistical signi cance (membranous- only, 33.3% vs. cytoplasmic, 17.6%, OR=2.3, 95% CI= 0.55-9.87, p=0.24). CONCLUSIONS: This study suggests that cytoplasmic ß-catenin expression may be linked with lower probability of achieving pCR after neoadjuvant chemotherapy. These data need to be validated in a larger cohort of patients.

Partial cloning and localization of leptin and leptin receptor in the mammary gland of the Egyptian water buffalo.

Originally an overall metabolic control was attributed to the leptin hormone, which is produced mainly by the adipose tissue. Recently, leptin gene expression was demonstrated in several additional peripheral tissues. Furthermore, several isoforms of leptin receptor were found both in the central nervous system and in the peripheral tissues. Using reverse transcription and polymerase chain reaction analysis we demonstrate that leptin is expressed both in the adipose tissue and in the lactating mammary gland tissue of Egyptian water buffalo. Our results show that, short and long isoforms of leptin receptor are expressed in buffalo mammary gland tissue. We have partially cloned the buffalo leptin and its short and long isoforms of receptor, which show a high sequence homology to previously published sequences of other mammalian species especially to that of other ruminants. Localization of leptin and its receptor mRNA transcripts, as determined by in situ hybridization procedure, revealed that leptin and its receptor transcripts are expressed specifically in the alveolar epithelial cells of the mammary gland. These morphological data support that leptin could also act as an autocrine and paracrine mediator for mammary gland metabolism and as a facilitator of alveolar epithelial cell activity during lactation.

Insertion of middle-ear Silastic sheeting during tympanoplasty: hearing outcomes.

OBJECTIVE: To study the effect of Silastic® sheeting placed in the middle ear during tympanoplasty, including the effect on hearing. DESIGN: Retrospective study. BACKGROUND: Chronic inflammation of the middle ear is common. Surgical treatment sometimes results in middle-ear adhesions and hearing deterioration. MATERIALS AND METHODS: We selected 106 patients with chronic otitis media, middle-ear adhesions and intact ossicles, based on intra-operative findings. These patients underwent single-stage tympanoplasty either with or without insertion of Silastic sheeting. Audiometry was undertaken pre-operatively and one and 12 months post-operatively. RESULTS: Patients who had undergone Silastic sheet insertion showed significantly better air conduction, bone conduction and air-bone gap averages one year post-operatively, compared with those who had not.

Endoscopic devascularisation of sphenopalatine bundle in intractable posterior epistaxis: technique, efficacy and safety.

OBJECTIVE: To evaluate endoscopic cauterisation of the sphenopalatine neurovascular bundle, as treatment for intractable posterior epistaxis, with regard to efficacy, safety and post-operative sequelae. PATIENTS AND METHODS: A prospective study reviewed 42 patients with severe posterior epistaxis who were treated with endoscopic cauterisation of the sphenopalatine neurovascular bundle, over a 17-month period. RESULTS: Hypertension and hepatic disease were present as predisposing factors in 66.7 and 35.7 per cent of patients, respectively. Branching of the sphenopalatine artery at its foramen was present in more than 85 per cent of patients. The success rate was 100 per cent, with no recurrent epistaxis in the follow-up period. Severe nasal dryness was present in only four patients (9.5 per cent); hypoaesthesia was found in the nasal mucosa of eight patients, without any patient complaints. CONCLUSION: Endoscopic sphenopalatine neurovascular bundle cauterisation is an effective treatment for refractory posterior epistaxis. In this study, neurovascular bundle cauterisation did not cause any neurological deficits or major complications.