Impact of physicochemical properties of nasal spray products on drug deposition and transport in the pediatric nasal cavity model.

The study is focused on the analysis of physicochemical properties of selected nasal sprays of mometasone furoate, and the influence of these properties on aerosol quality and penetration in the pediatric nose. After the determination of drugs surface tension and viscosity, spray geometry and size distribution of aerosol droplets, the topical delivery of each drug to different parts of the pediatric model of the nose with the flexible vestibule was evaluated by colorimetric visualization. All tested drugs are pseudo-plastic liquids, showing some differences in flow consistency constant k (range 714-1422) and flow behavior index n (range 0.16-0.31). At no-flow conditions, all sprays are deposited mainly in the anterior of the nasal cavity and the septum (2-3 cm from the nostril), as a result of inertial impaction of large droplets. The deposition range is slightly influenced by the geometry of the aerosol cloud, which, in turn, depends both on drug properties and the type of the spraying nozzle. Deposition experiments accompanied by the airflow show an enhancement of drug transport to deeper parts of the nasal cavity (up 4-6 cm from the vestibule), and this effect can be attributed to the secondary effects of spreading of the deposited liquid layer along the narrow air passages in the nose. Plume geometry, dose volume and rheological properties of the drug were shown to be important factors in the spray penetration pattern in the pediatric nose. The deepest delivery can be expected for drugs of low viscosity and short aerosol plumes.

[Unusual case of the long term presence of esophageal foreign body (non-radiopaque coin) in children]. / Niezwykly przypadek dlugo zalegajacego ciala obcego przelyku (niecieniujaca moneta) u dziecka.

The authors report an unusual case of a foreign body in the esophagus of a child present for longer than 2 years. As an infant this child had repair of esophageal atresia. She was examined and assessed 2 years ago for suspected foreign body swallowing. Chest and abdominal xrays did not show the presence of any foreign body. Now this child was re-admitted with a foreign body in the esophagus, a piece of meat. X rays showed narrowing at previous anastomosis site and dilatation proximally. At esophagoscopy after removal of the piece of meat, a coin was removed as well (50 Hungarian fills). This coin has low radiopacity so did not contrast well in soft tissue. It is worth pointing out that despite having a foreign body this child did not have any difficulty with swallowing and development was normal.

Deposition of intranasal glucocorticoids--preliminary study.

INTRODUCTION: Intranasal glucocorticoids are the treatment of choice in the therapy of rhinitis. The differences in efficiency of particular medications proven by therapeutic index may result from differences in composition of particular formulations as well as from diverse deposition in nasal cavities. Intranasal formulations of glucocorticoids differ in volume of a single dose in addition to variety in density, viscosity and dispenser nozzle structure. The aim of this report was to analyze the deposition of most often used intranasal glucocorticoids in the nasal cavity and assessment of the usefulness of a nose model from a 3D printer reflecting anatomical features of a concrete patient. MATERIAL AND METHODS: Three newest and most often used in Poland intranasal glucocorticoids were chosen to analysis; mometasone furoate (MF), fluticasone propionate (FP) and fluticasone furoate (FF). Droplet size distribution obtained from the tested formulations was determined by use of a laser aerosol spectrometer Spraytec (Malvern Instruments, UK). The model of the nasal cavity was obtained using a 3D printer. The printout was based upon a tridimensional reconstruction of nasal cavity created on the basis of digital processing of computed tomography of paranasal sinuses. The deposition of examined medications was established by a method of visualization combined with image analysis using commercial substance which colored itself intensively under the influence of water being the dominant ingredient of all tested preparations. On the basis of obtained results regions of dominating deposition of droplets of intranasal medication on the wall and septum of the nasal cavity were compared. RESULTS: Droplet size of aerosol of tested intranasal medications typically lies within the range of 25-150 µm. All tested medications deposited mainly on the anterior part of inferior turbinate. FP preparation deposited also on the anterior part of the middle nasal turbinate, marginally embracing a fragment of the central part of this turbinate as well together with deposition in the middle and superior nasal meatus reaching the region of nasal ceiling and olfactory field. MF preparation deposited on the anterior part of the inferior turbinate and central part of this turbinate alike. The area of mucous membrane of lateral wall of nasal cavity on which MF deposited was similar to the area achieved after the application of FP preparation but much greater than in the case of FF preparation. FF drug deposition concentrates only on the anterior part of the inferior turbinate. Despite directing the drug to the lateral wall of the nasal cavity a great proportion of examined preparations deposit also on the nasal septum. CONCLUSIONS: The practical application of tridimensional representation (3D printout) of actual geometry of nasal cavity to establish the deposition of inGKS was proven. Droplet size and the geometry of the aerosol cloud introduced into the nostril determine the significant deposition of medication droplets in the anterior part of the nasal cavity. Both physical properties of the drug as well as spraying system applied influence spatial distribution of the drug. The interaction of the air flow with the layer of deposited fluid plays a major role in the deposition of the drug in the nasal cavity, therefore it is so important that the drug does not drain by gravity but remains at the site of deposition which may be reinforced by thixotropic properties of the preparation.

[Subperiosteal orbital hematoma as a sinusitis complication]. / Krwiak podokostnowy oczodolu jako powiklanie zapalenia zatok przynosowych.

A case of subperiosteal orbital hematoma as a sinusitis complication--very rarely described in otolaryngological literature--is presented. Taking into account clinical examination and CT there was diagnosed subperiosteal orbital abscess but during surgery there was found hematoma. There has been discussed a clinical picture and a likely pathological mechanism of the complication as well as the performed surgical treatment.

[Long term administration of itraconazole with surgical treatment in fungal and bacterial infections of the paranasal sinuses]. / Dlugotrwale stosowanie itrakonazolu skojarzone z leczeniem chirurgicznym w zakazeniu mieszanym--grzybiczym i bakteryjnym zatok przynosowych.

A case of chronic paranasal sinuses with recurrent polyposis caused by miscellaneous infection--fungal (Aspergillus, Candida) and bacterial (Staphylococcus aureus, Enterobacter, Streptococcus) is described. The patient underwent 5 times surgical treatment (polypectomies, sinus operations). Good result was achieved after 2-years application of itraconazole and local Amphotericin B.

[Rare cases of neurofibroina in the head and neck]. / Rzadkie przypadki nerwiakowlókniaków glowy i szyi.

Four cases of neurofibroma rare localized in parapharyngeal space and throat, in external ear and larynx are described. Three of them were isolated tumors and in one case--tumors in external ears developed in course of general Recklinghausen disease. Two cases of neurofibroma in parapharyngeal space had different clinical, CT and microscopic picture. In one case tumor protruded the throat obturating its oral part with osseous elements in its microscopic structure which caused characteristic CT picture. This one was excised through median mandibulotomy with good anatomical and functional result. The second case of parapharyngeal neurofibroma adherent to the superior cervical vertebra and only slightly dislocated the postero-lateral wall of the throat was excised through external cervical approach.

[Unusual case of the ear cholesteatoma]. / Niezwykla postac perlaka ucha.

The authors present a case of temporal and occipital bone extensive destruction with epidural abscess of posterior cranial cavity and abscess of occipito-nuchal region created by giant cholesteatoma of the middle ear. There has been discussed a diagnosing troubles as well as performed surgical treatment.

[Otologic signs and symptoms as first manifestations of Wegener's granulomatosis with very severe clinical course--review of the literature and case report]. / Objawy uszne pierwszymi manifestacjami ziarniniaka Wegenera o bardzo ciezkim przebiegu klinicznym--przeglad pismiennictwa i opis przypadku.

A case of Wegener's granulomatosis in female aged 47 is described. Otological symptoms and signs connected with middle ear inflammation and masked mastoiditis about two months outstriped other signs particular from lower respiratory tract. The patient was surgically treated--antromastoidectomy was performed. After few days rapid worsening of patient's general state followed with hectic fever and inflammatory pulmonary changes. The patient was next treated in the Clinic of Pulmonary Diseases and Tuberculosis where the diagnosis of Wegener's granulomatosis was established on the basis of immunological findings (antibodies c-ANCA and PR3). The patient is treated from 9 months with cyclophosphamide and prednisone with improvement. The inability of ENT-surgeon in proper diagnosis and treatment in initial stage of the disease is stressed.

[Ocular and orbital complications of paranasal sinusitis]. / Powiklania oczne i oczodolowe zapalenia zatok przynosowych.

PURPOSE: The task of the research was epidemiological and clinical analyses of those patients. MATERIAL AND METHODS: In the period of 1976-200 147 patients with complications of perinasal sinusitis were treated. As numerous classifications of paranasal sinusitis complications exist, the analysis of the material was based on the modified classification proposed by the authors. The frequency of the complications was presented in 5-years periods. RESULTS: There were 133 patients treated due to ocular and orbital complications. In our material there were 79 patients (59.4%) up to 15 years of age and 54 patients (40.6%) older than 15 years. We noted 47 females (35.3%) and 86 males (64.7%). In evaluated 5-years periods the number of patients treated balanced between 17 and 37. In our material dominated orbital periostitis (palpebral edema)--103 cases (77.4%). Subperiosteal abscessus of the orbit was noted in 21 cases (15.8%), inflammation of the orbital tissue--in 5 cases (3.8%), orbital abscessus in 2 cases (1.5%), other rare complications--in 2 cases (1.5%). CONCLUSIONS: Generally the number of patients with ocular and orbital complications of paranasal sinusitis was changing in 5-years periods, but we did not notice any permanent tendency for increase or decrease. In the last 5 years we noted the increase in the number of complications, which was connected with the increase of the number of patients treated for orbital periostitis. In 2 patients we found rare orbital and ocular complications, that were not included in existing classifications. These were: orbital subperiosteal haematoma and episcleritis.