The involvement of the central nervous system in patients with COVID-19.

Coronaviruses disease (COVID-19) has caused major outbreaks. A novel variant, SARS-CoV-2, is responsible for COVID-19 pandemic. Clinical presentations and pathological mechanisms of COVID-19 are broad. The respiratory aspect of the disease has been extensively researched. Emerging studies point out the possibility of the central nervous system (CNS) involvement by COVID-19. Here, we discuss the current evidence for CNS involvement in COVID-19 and highlight that the high pathogenicity of SARS-CoV-2 might be due to its neuroinvasive potential.

Induction of smell through transethmoid electrical stimulation of the olfactory bulb.

BACKGROUND: Anosmia has an estimated prevalence of 5% of the general population. Outside of inflammatory causes, therapeutic options are limited despite research advances. Bypassing peripheral neuronal damage through central stimulation is a potential therapeutic option that has shown success in other sensory systems, most notably with hearing. We performed a pilot study to determine the feasibility of inducing smell through artificial electrical stimulation of the olfactory bulbs in humans. METHODS: Subjects with a history of sinus surgery, including total ethmoidectomy, with intact ability to smell were enrolled. The ability to smell was confirmed with a 40-item smell identification test. Awake subjects underwent nasal endoscopy and either a monopolar or bipolar electrode was positioned at 3 areas along the lateral lamella of the cribriform plate within the ethmoid sinus cavity. A graded stimulation current of 1-20 mA at 3.17 Hz was administered while cortical evoked potential (CEP) recordings were collected. Subjective responses of perceived smell along with reports of discomfort were recorded. Subjects with artificially induced smell underwent repeat stimulation after medically induced anosmia. RESULTS: Five subjects (age, 43-72 years) were enrolled. Three subjects reported smell perception smell with electrical stimulation. This was reproducible after inducing anosmia, but CEP recordings could not provide objective support. All subjects tolerated the study with minimal discomfort. CONCLUSION: This is the first report of induced smell through transethmoid electrical stimulation of the olfactory bulb. These results provide a proof of concept for efforts in development of an olfactory implant system.

Treatment of canine sinonasal aspergillosis with clotrimazole infusion in patients with cribriform plate lysis.

OBJECTIVE: To describe the treatment of sinonasal aspergillosis with topical 1% clotrimazole solution in dogs with cribriform plate lysis. MATERIALS AND METHODS: This retrospective study includes data retrieval from medical records of dogs with sinonasal aspergillosis and cribriform plate lysis that underwent topical treatment with 1% clotrimazole solution. RESULTS: Five dogs with sinonasal aspergillosis, cribriform plate lysis diagnosed on CT scans, and normal neurologic examinations were treated with a single (n=3) or multiple (n=2) infusions of clotrimazole solution. No dogs developed clinical neurologic disease after therapy. CLINICAL SIGNIFICANCE: In this study, a topical clotrimazole solution was not associated with adverse neurologic effects in neurologically normal dogs with sinonasal aspergillosis and cribriform plate lysis.

A re-examination of the human fossil specimen from Backi Petrovac (Serbia).

A fragmented human calotte was discovered during the early 1950s near Backi Petrovac (Serbia), in association with Palaeolithic stone tools. After its initial publication, the fossil specimen remained largely unknown outside of the Serbian academe and no detailed comparative study has ever been carried out. Since the whereabouts of the fossil itself are currently unknown, and given its potential significance for the Pleistocene human evolution, we re-examine the data published by Zivanovic (1966, 1975). Using the original measurements, mostly taken on the frontal bone, and a wide comparative sample of 68 fossil specimens, the fossil was compared and analyzed by statistical multivariate methods. We also conducted a visual examination of the morphology based on the available photographic material. Our analysis reveals phenetic similarity with Middle Pleistocene archaic Homo from Africa and anatomically modern Homo sapiens. However, the absence of primitive cranial traits in Backi Petrovac indicates a clear modern Homo sapiens designation. Although lost at the moment, there is a chance for the re-discovery of the fossil in the years to come. This would give us an opportunity to acquire absolute dates and to study the specimen in a more detailed manner.

[Progress in diagnosis of and therapy for idiopathic normal-pressure hydrocephalus--Lymphatic drainage of CSF and ISF from the brain: recent concept and hypothesis].

Cerebrospinal fluid (CSF) drains via the cribriform plate and nasal mucosa to cervical lymph nodes. There are no conventional lymphatics in the brain but physiological studies have revealed a substantial and immunologically significant lymphatic drainage from brain to cervical lymph nodes. Interstitial fluid (ISF) and solutes from brain parenchyma drain along capillary and perivascular space of artery, and path through the skull base, then reach to the cervical lymph nodes. CSF and ISF appear to drain by separate routes from the brain, especially in humans. However, there are interrelationships between the two fluid compartments that become more significant when drainage of CSF or ISF is impaired by disease processes. Vessel pulsations appear to be the driving force for the perivascular lymphatic drainage along artery walls, and as vessels stiffen with age, amyloid peptides (Aß) deposit in the drainage pathways as cerebral amyloid angiopathy (CAA). Blockage of lymphatic drainage of ISF and solutes from the brain by CAA may result in loss of homeostasis of the neuronal environment that may contribute to neuronal malfunction and dementia. Such failure of perivascular drainage may associated with the pathoetiology of Alzheimer's disease, cerebral small artery disease and idiopathic normal pressure hydrocephalus (iNPH).

[The use of degloving approach in the treatment of nasal-orbital-ethmoid fracture].

PURPOSE: To explore the method and effect of degloving approach in the treatment of nasal-orbital-ethmoid(NOE) complex fracture surgery. METHODS: Eleven cases of unilateral nasal-orbital-ethmoid fracture(NOE) were selected from Medical Center of Stomatology, Foshan Hospital of Traditional Chinese Medicine. 6 were orbital fracture, 5 were nasal fracture. All the patients were treated open reduction and rigid internal fixation or rhinoplasty via midfacial degloving approach. RESULTS: Eleven patients were followed up for 3 to 12 months, all patients had transient nasal crusting and bleeding,1 case had traumatic epiphora, 4 cases had infraorbital temporary numbness,1 case of crooked nose. CONCLUSIONS: The degloving approach can achieve the advantages of a widely exposed field for operation,no facial scar,and no complications such as nasal vestibular stenosis. It is worthy of wide clinical application.

Perioperative management for surgical correction of frontoethmoidal encephalomeningocele in children: a review of 102 cases.

BACKGROUND: Frontoethmoidal encephalomeningocele (FEEM) is a congenital neural tube defect characterized by herniation of brain and meninges through an anterior skull defect. The extruding mass results in a cutaneous expanding lesion and facial deformity. The objective of this study was to review perioperative management for surgical correction of this condition. METHODS: We reviewed the charts of FEEM children who were treated by surgical correction in King Chulalongkorn Memorial Hospital during 1995-2005. The collected data were categorized into preoperative, intraoperative and postoperative data. In addition, average blood loss was calculated. RESULTS: A total of 102 charts were reviewed. Preoperative data: The mean age of the patients was 4.62 years. Forty-six patients (45%) were smaller than average weight or height. Preoperative-associated abnormal conditions were found in 69 cases (68%). Intraoperative data: The mean duration of the anesthesia and surgery were 6.35 h and 5.51 h, respectively. The estimated mean red cell mass loss was 13.04 ml.kg(-1). There is one case of difficult intubation. No major anesthetic complication was found. Postoperative data: The average intensive care unit stay and hospital stay were 1.55 days and 11.51 days, respectively. The main postoperative complications were tonic-clonic seizure and serious infection including septic shock from wound infection and meningitis. CONCLUSIONS: We reported perioperative management in 102 FEEM children. Comprehensive care during preoperative, intraoperative and postoperative period is essential for successful outcome.

Bone-constructing cells from ethmoid bone may have multilineage differentiation potential: preliminary report.

OBJECTIVE: In order to investigate multilineage differentiation in human cultured cells from ethmoid bone, we conducted a morphological study to examine adipogenic and chondrogenic differentiation. MATERIAL AND METHODS: After reaching confluence, cells underwent terminal adipogenic differentiation by treatment with 100 microM indomethacin, 0.5 mM 1-methyl-3-isobutylxanthine, 1 microM dexamethasone (DEX), 10 microg/ml insulin and 0.3% dimethylsulfoxide in a medium supplemented with 10% fetal bovine serum. Chondrogenic differentiation was attempted by centrifuging a pelleted micromass using transforming growth factor-beta3 (TGF-beta3), DEX, ascorbic acid (AA), pyruvate acid, proline, glucose and (ITS)-plus. RESULTS: The cultured cells displayed adipocyte but not chondrogenic lineage under these conditions. Considering the possibility that some differentiation potential may be lost with in vitro culture but maintained using another chondrogenic differentiation medium containing TGF-beta1, it is possible that cultured cells may have multilineage potential, including chondrogenic differentiation ability. CONCLUSIONS: These morphological abilities of human cultured cells may indicate the possibility of the existence of mesenchymal stem cells in sinus bone. If mesenchymal stem cells exist in ethmoid bone, they may play an important role in future research on the regulation mechanisms of human bone tissue.

A Study on the Use Patterns of Alternative Therapy in the Elderly / 성인간호학회지

PURPOSE: The purpose of this study was to describe the using pattern of alternative therapies in the elderly. Method: 197 subjects, persons who were more than 60 years old, we interviewed. We modified and complemented Shin's(2000) instrument in accordance with purpose of this study. Data were analyzed statistically by using SAS program. RESULTS: 1. It was shown that 66.84% of subjects have utilized one or more types of alternative therapy. 2. It was shown that the most frequently used types are acupuncture (48.83%), and ethmoid bone therapy (42.75%). 3. Acupuncture was shown to be the most satisfactory type of therapy (14.50%). 4. There was a significant difference in the use ratio by sex; female 73.47% and male 60.20%. 5. Among users of alternative therapies, the most frequent responses to each question were as follows; 1. Motive of Use - "for complete cure of symptoms" (32.31%). 2. Side effects - "no side effects" (95.97%). CONCLUSION: We found that elderly persons used alternative therapies more frequently than others perpulations. Diet therapy and Hand therapy were most commonly used in older people. Although the elderly use alternative therapy, they cannot place confidence in its scientific reliability. Therefore, we need to examine the effects of alternative therapy.

A Study on the Use Patterns of Alternative Therapy in the Elderly / 성인간호학회지

PURPOSE: The purpose of this study was to describe the using pattern of alternative therapies in the elderly. Method: 197 subjects, persons who were more than 60 years old, we interviewed. We modified and complemented Shin's(2000) instrument in accordance with purpose of this study. Data were analyzed statistically by using SAS program. RESULTS: 1. It was shown that 66.84% of subjects have utilized one or more types of alternative therapy. 2. It was shown that the most frequently used types are acupuncture (48.83%), and ethmoid bone therapy (42.75%). 3. Acupuncture was shown to be the most satisfactory type of therapy (14.50%). 4. There was a significant difference in the use ratio by sex; female 73.47% and male 60.20%. 5. Among users of alternative therapies, the most frequent responses to each question were as follows; 1. Motive of Use - "for complete cure of symptoms" (32.31%). 2. Side effects - "no side effects" (95.97%). CONCLUSION: We found that elderly persons used alternative therapies more frequently than others perpulations. Diet therapy and Hand therapy were most commonly used in older people. Although the elderly use alternative therapy, they cannot place confidence in its scientific reliability. Therefore, we need to examine the effects of alternative therapy.

[Effect of intranasal treatment with capsaicin on polyp recurrence after polypectomy and ethmoidectomy].

OBJECTIVE: To evaluate the influence of polypectomy and anterior ethmoidectomy associated with intranasal applications of capsaicin on the recurrence of nasal polyps. METHOD: Fifty one patients (19 females, 32 males, mean age 43) undergoing polypectomy and anterior ethmoidectomy were included in the study. In 29 patients, a cotton pellet soaked with capsaicin (3 x 10(-6) mol, dissolved in 70% ethanol) was left into the middle meatus for 20 min under local anaesthesia. As a control group, 22 patients were treated with the capsaicin vehicle alone (70% ethanol). All patients studied received the intranasal capsaicin or vehicle treatment once a week for 5 weeks. The clinical objective examination and the subjective evaluation of nasal obstruction, rhinorrhea were recorded by means of a visual analogic scale graded from 0 to 4 throughout the study. RESULT: Patients treated with intranasal capsaicin application reported 9 months later and 55 months later separately, a marked reduction of their subjective evaluation of nasal obstruction when compared to the pretreatment evaluation (P < 0.01). In contrast, patients treated with the capsaicin vehicle alone did not have any significant improvement of their subjective evaluation of nasal obstruction. Subjective rhinorrhea was not modified by either treatment. Of 29 patients with capsaicin treatment, 25 (86.2%) patients (9 months later) and 20 (69%) patients (55 months later) showed satisfactory result, compared to 10 (45.4%) patients and 8 (36.4%) patients separately in the control group, the difference was significant (P < 0.01). CONCLUSION: Intranasal capsaicin application can reduce polyp recurrence and nasal obstruction after polypectomy and ethmoidectomy.

Local and regional anesthesia for functional endoscopic sinus surgery.

An effective topical and regional anesthetic technique using 25% cocaine paste combined with intravenous midazolam hydrochloride was used in 554 patients undergoing functional endoscopic sinus surgery. The operative fields were excellent and all procedures were completed with little patient disturbance. Patients recovered rapidly from sedation and were usually fit for discharge on the same day. There were no anesthetic complications. The major surgical complication rate was 0.5%.

The risk to olfaction from nasal surgery.

Implicit in all types of nasal surgery is the potential for worsening of olfactory function. Not only can injury occur to the delicate olfactory neuroepithelium itself, but also more indirect disturbances are engendered by pharmacologic agents, distortions of intranasal anatomy, persistent mucosal edema or crusts, and other processes. This study examined 93 patients undergoing various types of nasal surgery, including ethmoidectomy, polypectomy, Caldwell-Luc procedure, open reduction of nasal fracture, closed reduction of nasal fracture, rhinoplasty, and septoplasty. Factors considered as contributing to loss of olfactory acuity were age, gender, use of general anesthesia, and type of operation. The University of Pennsylvania Smell Identification Test (UPSIT), a 40-item, microencapsulated scratch-and-sniff procedure, was used to ascertain olfactory ability. Sixty-one patients (66%) had either improved or unchanged UPSIT scores after surgery; the remaining 32 patients (34%) had a decline in score. One patient (1%) became anosmic. Statistical treatment of outcome data using analysis of covariance with repeated measures showed no effect of age, gender, type of operation, or anesthetic.

Dental caries in relation to nutritional stress in early English child populations.

This research studied an association between dental caries prevalence in the primary dentition and cribra orbitale, an indicator of nutritional stress in archeological populations. Skeletal remains of 221 British children (Pre-Roman to Late Medieval) were examined, of whom 100 had orbital material available. Dental caries, as dmfs, was related to the presence of cribra orbitale (none, slight, moderate, or severe). Thus, data for 50 children showed a statistically significant association (P less than 0.005) between caries prevalence and cribra orbitale using the Fisher Exact Test, suggesting that nutritional stress is an associated factor in caries etiology in children.

[Historical notes on the ethmoid bone]. / Notes historiques sur l'ethmoïde.

The intriguing historical exploration of the anatomy of the ethmoid and ethmoidal cells is described. Despite continuing research, the ethmoid remains a puzzling topic.

[Personal endoscopic operative technic for the lateral nasal wall--an endoscopic surgery concept in the treatment of inflammatory diseases of the paranasal sinuses]. / Unsere endoskopische Operationstechnik der lateralen Nasenwand--ein endoskopisch-chirurgisches Konzept zur Behandlung entzündlicher Nasennebenhöhlenerkrankungen.

Many years of endoscopical investigation and observation have shown that most infections of the PNS are rhinogenic, spreading from the nose into the sinuses. Usually, a focus of infection in recurring sinusitis remains in stenotic areas of the anterior ethmoid, reinfecting the larger sinuses time and again. The anterior ethmoid, especially its infundibulum, thus holds a key position for reinfection or cure, and maxillary as well as frontal sinuses are fully dependent on the pathophysiological conditions obtaining in the anterior ethmoid. Endoscopic endonasal surgery under guidance of rigid endoscopes consequently aims at these primary focuses in the anterior ethmoid, clearing stenotic clefts and infected ethmoidal cells of diseased mucosa. For drainage and ventilation, the maxillary ostium is enlarged into the anterior nasal fontanelle. There is no need for any fenstration into the inferior nasal meatus. Once the ethmoidal focus is cleared, the dependent larger sinuses usually heal without having been touched themselves - even if their mucosal pathologies seemed almost irreversible. The endoscopic procedure, which is carried out in local and surface anaesthesia (excepting children) is described in detail. Excellent results with this method developed by Messerklinger, indicate that there is hardly any indication left for a Caldwell-Luc procedure in chronic recurring sinusitis.

[Temporary amaurosis in endonasal microsurgery of the ethmoid and lacrimal sac in local anaesthesia (author's transl)]. / Temporäre Amaurose bei mikrochirurgischer endonasaler Ethmoid- und Saccus-lacrimalis-Operation in Lokalanästhesie.

After injection of 1-2 cc. Scandicain and Suprarenin into the ethmoidalis vessels a female patient developed 1972 protrusio bulbi combined with amaurosis. After endonasal lacrimal sac operation with decompression of the orbita the protrusio bulbi disappeared without change of the amaurosis. Under the operating microscope no haematoma was found neither in the ethmoid nor in the orbita. Finally after 35-40 min. under an injection for blockage of the ganglion stellatum, the patient cried: "I can see light". Under further treatment, as known for acute hearing loss, the patient recovered a normal vision. In 1979 we have operated on 96 lacrimal sacs and all together 225 endonasal microsurgical ethmoid resections. After performing more than 8000 ethmoid operative procedures in the years before, a similar complication was observed in 1936 only. No persistent amaurosis was noticed. As amaurosis is extremely rare in our statistics on endonasal microsurgical ethmoid resections under reduction of blood pressure, there is no reason why the patient should be informed preoperatively about this rare complication.

The Kaleff-Hollwich technique and results of external dacryocysto-rhinostomy operation.

After a review of the history of lacrimal surgery the author describes the techniques of dacryocystorhinostomy which are currently performed. The ideal method is that of Ohm (1921) and Dupuy-Dutemps (1921) with its totally closed mucosal anastomosis. Because of the technical problems demonstrated with this technique the author recommends that of Kaleff (1937), modified by Hollwich (1977). The advantages of this method are: 1. The almost closed mucosal cavity which permits primary would healing. 2. The easy strain-free practicability particularly in cases of small scarred sac and pre-positioned ethmoid cells. 3. The sure fixation of the mucosal roof at the subcutis particularly in cases of marked swelling. Finally a survey of long-term and short term observations on all 324 cases from 1964 to 1977 is given.