Topical Steroids in Rhinosinusitis and Intraoperative Bleeding: More Harm Than Good?

The aim of this study was to assess whether the chronic preoperative administration of intranasal corticosteroids (INCs) in chronic rhinosinusitis with/without nasal polyposis (CRSwNP/CRSsNP, respectively) could significantly influence bleeding during functional endoscopic sinus surgery (FESS). We prospectively enrolled 109 patients (56 CRSwNP and 53 CRSsNP) candidate for FESS who underwent clinical evaluation and anamnestic data collection. They were allocated to 2 groups depending on whether or not they were chronic INC users, as declared at their first medical evaluation: chronic "INC users" represented the treated group, while "INC nonusers" formed the control group. Lund-Mackay and American Society of Anesthesiology (ASA) scores, blood loss expressed both in milliliters and using the Boezaart scale, operation time in minutes, pre- and postoperative 22-item Sino Nasal Outcome Scores (SNOT-22) were collected. Each sample underwent histopathological evaluation. The results showed that anamnestic information, Lund-Mackay, and SNOT-22 scores were similar between the 2 groups (P > .05). The average blood loss expressed in milliliters and operative time were slightly, but not significantly, higher in the INC user group, while the Boezaart scores proved significantly higher in the INC users (P = .038). No differences emerged between CRSwNP and CRSsNP within each group in terms of bleeding. The pathologist described common features in the majority (78%) of INC group samples: ectatic venules embedded in a fibrous stroma and hypertrophy of the arterial muscular layer. In our experience, despite the presence of NP, chronic preoperative administration of INCs was associated with increased intraoperative bleeding according the Boezaart scale although objective recordings of blood loss were not statistically different between the INC users and nonusers.

Primary Adenoid Cystic Carcinoma of the Frontal Sinus: Case Description of a Previously Unreported Entity and Literature Review.

Sinonasal adenoid cystic carcinoma is a rare malignant epithelial tumor characterized by slow growth, multiple local recurrences, and perineural invasion; surgery followed by radiotherapy provides the best overall survival by means of an endoscopic, craniofacial, or combined approach. We present a previously undescribed case of frontal sinus adenoid cystic carcinoma involving the subcutaneous tissue and the dura mater treated with an open technique, free flap reconstruction, and hadron therapy together with a summary of the state of the art.

Clean rhodium nanoparticles prepared by laser ablation in liquid for high performance electrocatalysis of the hydrogen evolution reaction.

Rhodium nanoparticles (NPs) were prepared by a one-step, green and facile procedure consisting in laser ablation of a bulk Rh target immersed in pure water (W-Rh-NPs) or ethanol (E-Rh-NPs). When embedded in mesoporous carbon based inks, both W-Rh-NPs and E-Rh-NPs show excellent activity towards the hydrogen evolution reaction in acidic media, operating close to the thermodynamic potential with 85-97% faradaic yields and low Tafel slopes of 50-54 mV per decade in the low overpotential region (η < 20 mV). A superior activity of W-Rh-NPs with respect to E-Rh-NPs is ascribed to the absence of surface carbon reducible species derived from the synthesis in organic solvent, and thus confirms the importance of the use of water as the preferred medium for laser synthesis of clean nanocrystals in liquid environment. These results provide an important contribution to the impelling need for the preparation of nano-catalysts based on energy critical materials by clean, sustainable and low cost routes.

Acid-catalyzed formal cycloaddition of α,ß-unsaturated carbonyls with epoxides: dioxepines or acetals?

It has been recently reported that the reaction of α,ß-unsaturated carbonyl derivatives with epoxides in the presence of a homogeneous acid catalyst readily delivers the corresponding dioxepines via formal (4 + 3) cycloaddition. We report herein that the same apparent reactivity can be triggered via heterogeneous catalysis. Characterization of products by means of NMR correlation experiments and DFT modeling revealed, however, that products are the acetals of the unsaturated reagent rather than the desired heterocycles.

Alpha-fluorotropinone immobilized on silica: a new stereoselective heterogeneous catalyst for epoxidation of alkenes with oxone.

The dioxirane-mediated epoxidation of alkenes in the presence of supported alpha-fluorotropinones 5 and 9 has been evaluated. The catalysts anchored onto silica supports 5 have shown comparable activity with respect to the homogeneous counterpart 10 and good stability on recycling. In the second part of this paper the enantiomerically enriched alpha-fluorotropinone 4 was anchored onto both mesoporous MCM-41 and amorphous KG-60 silicas. The chiral-supported catalysts promoted the stereoselective epoxidation of several trans-substituted and trisubstituted alkenes with ee values up to 80% and were perfectly reusable with the same performance for at least three catalytic cycles.

Heterogeneous enantioselective epoxidation of olefins catalysed by unsymmetrical (salen)Mn(III) complexes supported on amorphous or MCM-41 silica through a new triazine-based linker.

High enantioselectivity (ee up to 84%) has been achieved in heterogeneous asymmetric epoxidation using a silica-bound unsymmetrical (salen)-manganese(III) complex; amorphous silica can be used in the same way as MCM-41, showing a positive effect in the catalyst recycling.

Change in portal flow after liver transplantation: effect on hepatic arterial resistance indices and role of spleen size.

Information on changes in splanchnic hemodynamics after liver transplantation is incomplete. In particular, data on long-term changes are lacking, and the relationship between changes in arterial and portal parameters is still under debate. The effect of liver transplantation on splanchnic hemodynamics was analyzed with echo-Doppler in 41 patients with cirrhosis who were followed for up to 4 years. Doppler parameters were also evaluated in 7 patients transplanted for acute liver failure and in 35 controls. In cirrhotics, portal blood velocity and flow increased immediately after transplantation (from 9.1 plus minus 3.7 cm/sec to 38.3 plus minus 14.6 and from 808 plus minus 479 mL/min to 2,817 plus minus 1,153, respectively, P <.001). Hepatic arterial resistance index (pulsatility index) also augmented (from 1.36 plus minus 0.32 to 2.34 plus minus 1.29, P <.001) and was correlated with portal blood velocity and flow. The early changes in these parameters were related, in agreement with the hepatic buffer response theory. Portal flow returned to normal values after 2 years. Superior mesenteric artery flow normalized after 3 to 6 months. Splenomegaly persisted after 4 years, when spleen size was related to portal blood flow. In 7 patients transplanted for acute liver failure, portal flow, and hepatic arterial resistance index were normal after transplantation. In conclusion, a high portal flow was present in cirrhotics until 2 years after transplantation, probably because of maintenance of elevated splenic flow. An early increase in hepatic arterial resistance indices is a common finding, but it is transient and is related to the increase in portal blood flow. A normal time course of portal-hepatic hemodynamics was detected in patients transplanted for acute liver failure.

Stereoselective Synthesis of Optically Active 2-Hydroxymandelic Acids and Esters via Friedel-Crafts Coordinated Reaction: Crystal Structure of Chiral Dichloro[2-(1-oxido-1-menthoxy- carbonylmethyl)-4-methoxyphenoxido-O,O,O]titanium.

Highly diastereoselective hydroxyalkylation of phenols with chiral glyoxylates was performed. Hydrolysis or reduction of the esters 3 afforded 2-hydroxymandelic acids 6 and diols 5 in high yields and enantiomeric pure form. Mechanistic evidence of chelation-controlled reaction comes from the crystal structure determination of titanium phenoxide complex 8.