Sonic aerosol therapy to target maxillary sinuses.

AIM: Intranasal aerosol administration of drugs is widely used by ENT specialists. Although clinical evidence is still lacking, intranasal nebulization appears to be an interesting therapeutic option for local drug delivery, targeting anatomic sites beyond the nasal valve. The sonic nebulizer NL11SN associates a 100Hertz (Hz) sound to the aerosolization to improve deposition in the nasal/paranasal sinuses. The aim of the present study was: to evaluate in vivo the influence of associating a 100Hz sound on sinus ventilation and nasal and pulmonary aerosol deposition in normal volunteers, and; to quantify in vitro aerosol deposition in the maxillary sinuses in a plastinated head model. MATERIAL AND METHODS: Scintigraphic analysis of (81m)Kr gas ventilation and of sonic aerosol ((99m)Tc-DTPA) deposition using the NL11SN was performed in vivo in seven healthy volunteers. In parallel, NL11SN gentamicin nebulization was performed, with or without associated 100Hz sound, in a plastinated human head model; the gross amount of gentamicin delivered to the paranasal sinuses was determined by fluorescence polarization immunoassay. RESULTS: Associating the 100Hz sound to (81m)Kr gas ensured paranasal sinus ventilation in healthy volunteers. (99m)Tc-DTPA particles nebulized with the NL11SN were deposited predominantly in the nasal cavities (2/3, vs 1/3 in the lungs). In vitro, the use of NL11SN in sonic mode increased gentamicin deposition threefold in the plastinated model sinuses (P<0.002); the resulting antibiotic deposit would be sufficient to induce a local therapeutic effect. CONCLUSION: The NL11SN nebulizer ensured preferential nasal cavity aerosol deposition and successfully targeted the maxillary sinuses.

Nonspecific human immunoglobulin G for imaging infection and inflammation: what did we learn?

Radiolabeled human non specific immunoglobulin G (IgG or HIG) was proposed in the early nineties as a potential tracer for imaging infection and sterile inflammation. Formulations with ¹¹¹In and (99m)Tc as the label were developed and extensive preclinical work was undertaken to assess its potential as a diagnostic agent. ¹¹¹In-HIG was used in a number of clinical studies and proved efficient in detecting orthopedic infections, especially in patients with prostheses, fever of unknown origin, opportunistic infections in immunocompromised patients, including patients infected with the human immunodeficiency virus and neutropenic patients. In the latter patients, there was no need for blood manipulation to harvest white cells for leukocyte labeling which was a considerable advantage. (99m)Tc-HIG was also successfully used for imaging sterile arthritis, especially rheumatoid arthritis. Two decades later, radiolabeled HIG is almost completely abandoned as a general purpose tracer for imaging infection and inflammation and this article aims to find out why this has happened.

[Clinical aspects of leukemic infiltration of the choroid and the optic nerve]. / Aspects cliniques de l'infiltration leucémique de la choroïde et du nerf optique.

A case of presumed leukemic infiltration of the choroid and two cases of leukemic involvement of the optic nerve are presented. These complications are rarely observed clinically. Leukemic infiltration of the choroid may cause a serous detachment of the retina, which is often bilateral. The fluoroangiographic aspect is similar to what is observed in acute choriocapillaris occlusion. Leukemic involvement of the optic nerve first appears as papilledema. In more advanced cases the optic disc and the peripapillary retina are covered by a white-yellowish infiltrate which protrudes into the vitreous. The diagnosis is confirmed by CT scan of the orbit and the cerebro-spinal fluid often contains leukemic cells. As optic nerve infiltration is often associated with CNS involvement the prognosis is usually poor. Intrathecal chemotherapy has little effect on the intraocular manifestations, which however respond to orbital radiotherapy.