Facial trauma.

Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

Epidemiology of ENT emergencies.

OBJECTIVE: To give an overview of ear, nose, and throat (ENT) pathologies encountered in the emergency room (ER). METHODS: Retrospective analysis of 1296 files of patients visiting the ER between January 2008 and December 2012. Diagnosis, treatment, hospitalisation, referral, and demographic parameters were evaluated. RESULTS: Epistaxis is the most frequent ENT condition seen in the ER. One third of epistaxis patients are on anticoagulant therapy. The second most frequent conditions observed were infections of the pharynx and tonsils. Nasal fractures and vertigo were also frequently observed. CONCLUSION: Epistaxis and its treatment were the most frequent ENT diagnosis and therapy seen in the ER. Infections are the main cause of hospitalisation. Referral to other disciplines and revisits seldom occurred.

Comparing the microdebrider and standard instruments in endoscopic sinus surgery: a double-blind randomised study.

UNLABELLED: Comparing the microdebrider and standard instruments in endoscopic sinus surgery: a double-blind randomised study. OBJECTIVE: It is frequently stated that microdebriders provide better mucosal preservation in endoscopic sinus surgery (ESS), and therefore better and faster healing, when compared to the standard Blakesley instruments. However, evidence from comparative prospective studies is lacking. In this study, we compared the results of microdebriders with traditional surgical instruments for ESS. METHODS: A prospective, randomised, comparative, double-blind study in 50 patients undergoing bilateral ESS. Each patient was operated on with both instruments: one side of the nose with the microdebrider only, and the other side with standard instruments. The outcome of surgery was measured by using a symptom score and an endoscopic score at five time points during the first six postoperative months. RESULTS: Both instruments resulted in symptom improvement and in endoscopically visible healing over time, but no significant difference was found between the two techniques. In endoscopic evaluation, only the total score at 3 weeks after surgery was significantly better in the microdebrider group. No significant difference was found at any other time point. Synechia formation, patency of middle meatal antrostomy, and open access to the ethmoid were the same in both groups. CONCLUSION: In this study of endoscopic sinus surgery the use of the microdebrider does not offer major advantages compared to the standard instruments.

Hemodynamic effects of isometric exercise and mental arithmetic in hypertension treated with selective and nonselective beta-blockade.

Hypertensive patients have an unfavorable pressor response to exogenous epinephrine during nonselective beta-blockade. We studied hemodynamics during epinephrine release induced by handgrip exercise and mental arithmetic to examine the clinical relevance of this phenomenon. Twenty-two hypertensive patients were examined in a double-blind crossover experiment with placebo, propranolol (240 mg daily), placebo-washout, and metoprolol (300 mg daily). Changes induced by stress tests for systolic and diastolic blood pressure, heart rate (HR), and forearm blood flow (FBF) were of the same order on both beta-blockers. Rises in HR and FBF were equally reduced by both drugs. Neither handgrip exercise nor mental arithmetic induced significant differences in reaction during selective and nonselective beta-blockade.

Impaired vasodilation during long-term beta 1-selective beta-blockade in hypertensive patients.

In eight patients with essential hypertension the effect of 50 mg atenolol, once daily for 6 months, on vasodilation during epinephrine infusion and submaximal dynamic exercise was studied. The normal decrease of diastolic blood pressure during bicycle exercise, reflecting a decrease in total peripheral resistance not mediated by circulating epinephrine, disappeared during atenolol treatment. Low-dose infusion of epinephrine had no influence on systolic blood pressure both before and after atenolol. However, the decrease of diastolic blood pressure occurring before atenolol was abolished and the increase in heart rate was attenuated during atenolol treatment. Forearm vascular resistance decreased before and during atenolol to the same extent. So the normal physiologic vasodilation during submaximal dynamic exercise seems impaired during long-term treatment with atenolol. In addition the normal vasodilating response to an increase of circulating epinephrine to levels occurring during daily life stress seems impaired even with the low dose of this beta 1-selective beta-blocker.

The influence of intrinsic sympathomimetic activity and beta-1 receptor selectivity on the recovery of finger skin temperature after finger cooling in normotensive subjects.

A double-blind randomized study was designed to investigate differences in the recovery of finger skin temperature after finger cooling during dosing with placebo or one of four beta-blockers: propranolol, atenolol, pindolol, and acebutolol. In 11 normotensive nonsmoking subjects, finger skin temperature was measured with a thermocouple before and 20 minutes after immersion of one hand in a water bath at 16 degrees C. This finger cooling test caused no significant changes in systemic hemodynamics such as arterial blood pressure, heart rate, and forearm blood flow. The recovery of finger skin temperature during propranolol dosing was better than that during pindolol and atenolol dosing. There were no differences between the recoveries of skin temperature during pindolol, atenolol, and acebutolol dosing. Thus we could demonstrate no favorable effect of intrinsic sympathomimetic activity or beta 1-selectivity on the recovery of finger skin temperature after finger cooling.

Disparate effects of mental stress on plasma noradrenaline in young normotensive and hypertensive subjects.

The response of blood pressure, heart rate and plasma catecholamines to a mental arithmetic and a cold pressor test was studied in 70 patients with mild essential hypertension and in 41 age- and sex-matched normotensives. Each group consisted of three prospectively stratified age classes: 20-29, 30-39 and 40-55 years. During mental arithmetic, hypertensives showed only a higher increment of systolic blood pressure (+17-19%) than normotensives (+12-15%). Plasma noradrenaline in the youngest normotensives (20-29 years) showed a small but significant decrease (-0.20 +/- 0.07 nmol/l) whereas the youngest hypertensives showed a small but significant increase of plasma noradrenaline (+0.14 +/- 0.04 nmol/l). The difference between both groups was highly significant (P less than 0.001). In the two older age classes there was no difference in plasma noradrenaline response between normo- and hypertensives. During the cold pressor test both the cardiovascular and plasma noradrenaline response were of the same magnitude in normo- and hypertensives. These data reinforce the concept that the increased sympathetic reactivity to mental stress in hypertensives may be restricted to the younger age.

Cardiovascular responsiveness to norepinephrine in mild essential hypertension.

The responses of blood pressure, heart rate and forearm vascular resistance to exogenous norepinephrine (NE) were measured in 40 normotensive and 65 mildly hypertensive subjects (mean blood pressure 117/72 and 146/92 mm Hg, respectively). Both groups received low incremental doses of NE: 15, 30 and 60 ng/kg/min for 8 minutes each. In contrast to previous studies that compared the dose-response curves in normo- and hypertensive subjects, this study corrected the cardiovascular responses for the increment of plasma NE to account for differences in metabolic clearance of NE. Although age and sex appeared to play a role, the corrected cardiovascular responses did not differ significantly between normo- and hypertensive subjects. Thus, an increased cardiovascular sensitivity to exogenous NE was not demonstrated in mildly hypertensive subjects. This finding confirms some but not all previous studies of the dose-response relation.

Comparison of blood pressure response to exogenous epinephrine in hypertensive men and women.

This study investigated possible differences between hypertensive men and hypertensive women concerning the hemodynamic effects of incremental doses of exogenous epinephrine. The study population comprised 38 men (37 +/- 10 years) (standard deviation) and 25 women (33 +/- 9 years) with mild essential hypertension (mean blood pressure 147/90 and 147/93 mm Hg, respectively). Body mass index was slightly higher in men (25 +/- 3 kg/m2) than in women (23 +/- 2 kg/m2). Both groups received an intravenous infusion with epinephrine of 15 and 30 ng/kg/min for 8 minutes each. Despite the similar doses of epinephrine infused in both groups, the increase of venous plasma epinephrine in men was nearly twice that in women (1.04 +/- 0.09 vs 0.67 +/- 0.09 nmol/liter, p less than 0.01), suggesting that women cleared the infused epinephrine more efficiently than men. At the highest infusion dose, the increase of systolic blood pressure was larger in men than in women (5.3 +/- 1.2 vs 1.7 +/- 1.1 mm Hg, p less than 0.05). Conversely, the decrease of diastolic blood pressure was also larger in men than in women (-8.8 +/- 1.0 vs -5.8 +/- 1.0 mm Hg, p less than 0.05). The heart rate increased to the same extent in both groups (11.5 +/- 0.8 and 13.7 +/- 1.2 beats/min). If the blood pressure responses were corrected for the increase of plasma epinephrine, the difference between men and women disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)

Sexual dysfunction after renal replacement therapy.

The existence of a sexual problem as the subjective evaluation of sexual function was assessed with a simple questionnaire. Those questioned were patients undergoing dialysis treatment (n = 400) or with a functioning renal transplant (RTx; n = 300) and both men and women in the general Dutch population (n = 591). In the Dutch control population, 8.7% of the men and 14.9% of the women reported a sexual problem, showing a significant gender difference but unrelated to age. In patients, the prevalence of a sexual problem was significantly greater (hemodialysis, men, 62.9%; women, 75.0%; peritoneal dialysis, men, 69.8%; women, 66.7%; renal transplantation, men, 48.3%; women, 44.4%). In RTx recipients, sexual problems were significantly less prevalent than in patients undergoing dialysis (P < 0.001). Only in male patients was an association between prevalence of a sexual problem and age found. The results of the simple questionnaire were sufficiently validated when 102 of 104 patients confirmed their responses in a subsequent structured interview. This study shows that the prevalence of sexual problems in patients undergoing renal replacement therapy is high and clinically relevant.

A genetic-correlational study of hippocampal structural variation and variation in exploratory activities of mice.

Our previous work provided evidence that hippocampal opioid peptides form an important neurochemical substrate underlying the gene-dependent exploratory behavior of mice. A prominent hippocampal opioid is dynorphin B, which resides in the mossy fibers exclusively. In order to seek support for causal relationships between dynorphinergic hippocampal mechanisms and exploration, a quantitative-genetic method was chosen. For this purpose, mice from the inbred strains C57BL/6, DBA/2, BLN, and CPB-K were used. Their hippocampal mossy fiber projections were visualized by means of immunohistochemistry, using a highly specific anti-dynorphin B antiserum. The additive-genetic correlations that were estimated suggest pleiotropic gene effects on locomotion, rearing-up, wall-leaning, and several intra- and infrapyramidal mossy fiber (iipMF) variables. Long iipMF, in particular, were found to be associated with high exploratory activity.

A genetic-correlational study of hippocampal neurochemical variation and variation in exploratory activities of mice.

Previously, we have demonstrated that hippocampal mossy fibers, containing the opioid peptide dynorphin B, are functionally connected with the gene-dependent exploratory behavior of mice. In order to seek further evidence of causal relationships between dynorphin B action and exploration, a quantitative-genetic method was chosen. For this purpose, mice from the inbred strains C57BL/6, DBA/2, BLN, and CPB-K were used. By means of radioimmunoassay, the hippocampal level of dynorphin B was monitored in mice that had been exposed to environmental novelty, as compared to naive animals. Clear evidence was obtained that novelty induces the release of hippocampal dynorphin B. Furthermore, low tissue content was found to be causally connected with high exploratory scores.

Prognostic factors for the vascular components of erectile dysfunction in patients on renal replacement therapy.

A total of 76 male patients on renal replacement therapy (RRT) were investigated. Erectile dysfunction (ED) was defined as insufficient erection during visual erotic stimulation (VES) or during sleep as measured with Rigiscan and Erectiometer. Data on medical history, physical examination, and laboratory variables were collected. Furthermore, penile pharmacological duplex ultrasonography (PPDU) was performed. Univariate and multivariate logistic regressions were used to determine prognostic values and to develop prognostic models. Independent prognostic factors for ED were the number of cardiovascular events, waist-hip ratio, body mass index, and acceleration time (AT) as measured with PPDU. Independent prognostic factors for an abnormal AT (>100 ms) were number of cardiovascular events, age category, and the presence of carotid bruits. Independent prognostic factors for insufficient veno-occlusion during PPDU were number of cardiovascular events and supine diastolic blood pressure. The vascular contribution to ED in patients on RRT is substantial. Data from medical history, limited physical examination, and PPDU contribute to the prediction of the vascular contribution to ED.

Buffering capacity of human semen.

The buffering capacity of 270 semen samples derived from 196 men of infertile couples was determined from titration curves. The average buffering capacity in the physiologic range (pH 7.0 to 6.0) was 41.1 slyke (standard deviation [SD], 9.9), which is significantly higher (P less than 0.01) than that in serum (23.3 slyke; SD, 7.5; n = 42). When the buffering capacity of several semen samples of one man in the course of time was measured, the variation between these samples was larger than the determination error. No correlation was found between the buffering capacity of serum and semen of the same man, nor between the buffering capacity of semen and the fertility grade determined by physical and morphologic analysis of the samples.

Unreliability of self-reported burning tendency and tanning ability.

Burning and tanning histories were studied in 790 white students 18 to 30 years of age by means of a self-administered questionnaire. Only 325 cases (41.1%) were classifiable according to the Fitzpatrick scheme (skin types I to IV). Skin type I (always burn, never tan) was recorded only twice (0.3%). The minimal erythemal dose was measured in a subgroup of 197 students; these results showed no significant correlation with the self-reported burning tendency. In 508 students the burning-tanning histories were compared with eye and hair color, freckling tendency, and number of moles. The tanning ability showed a better correlation with skin complexion characteristics than the burning tendency. It is concluded that self-reported burning-tanning histories form an unreliable means of skin typing.

The concentration of blood components related to fuel metabolism during prolonged fasting in children.

In order to study the relationship between sex, age and glucose, and the concentrations of various fuel related blood substrates in children during prolonged fasting, we have selected data of fasting procedures in 13 control children aged 3-5 yr, fasted 24 h, and 58 control children aged 6-15 yr, fasted 40 h. Compared to the blood results after overnight fast, glucose is decreased, and lactate, pyruvate, ketones and non-esterified fatty acids (NEFA's) are all clearly increased at the end of fast. The concentrations of alanine and triglycerides remain unchanged. The relation with sex, age and glucose has only been analyzed in the older children group. A sex-dependency is indicated for the ketones. Ketones are negatively related with age. NEFA's pyruvate and alanine are not age-related, whereas glucose, lactate and triglycerides are moderately age-dependent. Ketones are negatively related with glucose, whereas pyruvate, NEFA's and triglycerides are not glucose-related. Lactate and alanine are weakly related to glucose. The data demonstrate diminished glucose homeostasis and increased ketogenesis in younger children compared to older ones during prolonged fasting.

Reference values of blood components related to fuel metabolism in children after an overnight fast.

The interrelation between blood components, involved in fuel metabolism, and age, sex and glucose was studied in 72 control children (26 girls and 46 boys, aged between 3 and 15 yr) after an overnight fast (14 h). Glucose, lactate, pyruvate, triglycerides and cholesterol are age-independent. Alanine is positively correlated, whereas beta-hydroxybutyrate, acetoacetate and NEFA's are negatively correlated with age. With respect to blood sugar, acetoacetate, NEFA's and cholesterol are glucose-independent. Lactate, pyruvate, alanine and triglycerides are positively correlated with glucose, and beta-hydroxybutyrate--and total ketone bodies--are negatively correlated with glucose. Except for triglycerides, no differences in the concentrations of the above mentioned blood substrates are seen between boys and girls. These data demonstrate that after an overnight fast lipolysis and ketogenesis already are active in young children, probably related to inadequate gluconeogenesis and improvement of carbohydrate regulation with age.

CSF concentration and CSF/blood ratio of fuel related components in children after prolonged fasting.

In order to obtain information about blood and cerebrospinal fluid (CSF) concentrations, and CSF/blood ratio data of fuel related substrates at the end of a prolonged fast in children, we have selected biochemical data from fasting test procedures in 11 control children aged 3-5 yr, fasted 24 h, and 58 control children aged 6-15 yr, fasted 40 h. There was a good correlation between blood and CSF concentrations for glucose, acetoacetate and beta-hydroxybutyrate. The relation with age and sex has been analyzed only in the older children. CSF and blood values for glucose are positively related with age, and both ketones are negatively related with age. Lactate, pyruvate and alanine concentrations in blood and CSF are not related with age, except for CSF pyruvate. With respect to the CSF/blood ratio for the above mentioned components, only the value for acetoacetate is sex and age related. The calculated median caloric values for the sum of glucose, lactate, pyruvate and ketones in CSF are independent of age at the end of a 40-h fast. The diminished glucose contribution on the CSF caloric homeostasis in younger children is fully compensated by the ketone bodies.

Photorefractive keratectomy with an ablatable mask for myopic astigmatism.

PURPOSE: To evaluate efficacy, safety, and stability of photoastigmatic keratectomy (PARK) carried out with a Summit Apex Plus laser using an ablatable mask. METHODS: Forty-one eyes of 41 patients with myopic astigmatism with follow-up of 12 months were evaluated. Treatment efficacy was compared in groups with high (>6.00 D) versus low (< or =6.00 D) preoperative spherical equivalent subjective manifest refraction, in groups with high (>2.00 D) versus low (< or =2.00 D) preoperative cylindrical component and in groups divided according to preoperative axis of cylinder. RESULTS: At 12 months after surgery, mean spherical equivalent manifest refraction in all 41 eyes was -0.30 +/- 0.90 D. Mean cylinder component was 0.60 +/- 0.70 D. Mean reduction in astigmatic component was 67 +/- 47%. Uncorrected visual acuity of 0.5 or more was achieved in 79% of eyes; 71% of eyes achieved 0.8 or more. At 1 month after surgery, 49% of eyes had a loss of 2 or more lines of spectacle-corrected visual acuity. This loss was restored at 12 months. No statistically significant differences were found between the different subgroups. CONCLUSION: Photoastigmatic keratectomy with ablatable mask gives satisfactory results. No relation in efficacy was found when taking into account the amount of preoperative spherical component, the cylindrical component, or the cylinder axis direction.

S100B protein, glia and Gilles de la Tourette syndrome.

Activated glial cells play an important role in a variety of neurological disorders. This study examines S100B protein levels in the serum of patients with Gilles de la Tourette syndrome, as potential marker for glial cell function. Two groups of children were examined: 61 reference patients and 33 patients with Gilles de la Tourette syndrome. It was found that S100B serum concentrations in the reference group decrease with increasing age. Furthermore it was found that the mean S100B concentration in serum of children with Gilles de la Tourette syndrome is significantly higher than in the reference group. These preliminary results suggest that glial tissue might be involved in the pathophysiology of the syndrome.