[Fever, coughing and/or wheezing in young children: consider the possibility of foreign body aspiration]. / Koorts, hoesten en/of piepen bij jonge kinderen: vergeet het corpus alienum niet.

Three children, 2 girls aged 1.5 and 3 years and a 2-year-old boy, experienced coughing, wheezing and/or fever for several days or weeks. The first girl was treated for asthma, the other two children for pneumonia. Because the symptoms persisted in all three children after treatment was started, the diagnosis of foreign body aspiration was suggested and confirmed by bronchoscopy. The foreign body was removed during the bronchoscopy and in the boy, a mucosal lesion in the piriform fossa was sutured. Thereafter, all the children recovered completely. In children with persistent coughing, wheezing or fever despite treatment for pneumonia or asthma and in absence of a characteristic acute incident, foreign body aspiration should be considered.

The hinged-door composite septal flap as structural support and lining of nasal reconstruction by a forehead flap.

In this paper we describe four patients who underwent extensive nasal surgery for carcinoma in the nasal vestibule. Two patients underwent salvage surgery after radiotherapy, whereas the other two patients were treated with primary surgery. In all cases the nasal defect was reconstructed using a composite hinged-door septal flap for structural support and internal lining combined with a paramedian forehead flap which supplied the skin coverage. All patients had a pleasing aesthetic and good functional result. The combination of a paramedian forehead flap with a composite hinged-door septal flap is an excellent reconstruction procedure for defects of the lateral nasal wall and alar region.

Neuroendocrine carcinoma of the sphenoid sinus: a case report.

The presentation of a neuroendocrine carcinoma in the paranasal sinuses is extremely rare. Until now only 25 cases have been reported in the literature. We report a case of a 65-year-old male with an atypical carcinoid of the sphenoid sinus which seemed to be associated with multiple endocrine neoplasia type 1 (MEN 1). To the best of our knowledge this is the first report on an atypical carcinoid in the sphenoid sinus.

Inhibition of nitric oxide synthase by nasal decongestants.

The nasal decongestants oxymetazoline and xylometazoline are frequently used in the topical treatment of rhinitis and sinusitis. As nitric oxide (NO) is thought to play a role in inflammation of the upper respiratory tract, the aim of this study was to examine the in vitro effects of these compounds on the activity and the expression of NO producing enzymes, including the inducible form of NO synthase (iNOS) and the constitutive isoform of NO synthase (cNOS). Experiments concerning the effects of both compounds on enzymatic activity and enzyme induction of iNOS were performed in a lipopolysaccharide (LPS) induced rat alveolar macrophage cell line (NR8383) using the Griess assay and the 3H-citrulline assay respectively. The effects on cNOS were examined in fresh rat synaptosomes using the 3H-citrulline assay. The direct scavenging properties of both compounds were investigated using a amperometric NO sensor. Oxymetazoline and xylometazoline were shown to have a dose dependent inhibitory effect on total iNOS activity indicated by nitrite/nitrate formation in the Griess assay. This effect was found to be due to an inhibition of induction of the enzyme rather than inhibition of the enzyme activity, as was investigated in two separate experiments using the 3H-citrulline assay. Inhibition of cNOS was moderate and in the same order of magnitude as the inhibition of enzymatic iNOS activity. Direct scavenging of NO could not be detected. As constitutive nitric oxide synthase activity is thought to serve beneficial physiological functions, and exaggerated inducible nitric oxide synthase activity may cause exacerbation of the inflammatory process, pharmacological treatment influencing the nitric oxide generating system should focus on inhibition of inducible nitric oxide synthase alone. The specific characteristics of these decongestants in vitro suggests suitability for this application and may indicate an additional beneficial effect in the treatment of upper respiratory tract inflammation.

Submandibular approach for excision of a large schwannoma in the base of the tongue.

A 24-year-old Turkish woman is described, who gradually developed progressive swallowing problems over 6 months due to a tumor in the base of the tongue. Magnetic resonance imaging showed a large well-circumscribed solid mass. Histopathological examination of an incisional biopsy showed a schwannoma. The tumor was completely removed through a submandibular approach. The postoperative course was uneventful and her complaints disappeared. The submandibular approach used gave an excellent exposure of the base of tongue with a less obvious scar than a lip-splitting incision.

Local treatment of generalised peritonitis in rats; effects on bacteria, endotoxin and mortality.

OBJECTIVE: To assess the effect of debridement, intraoperative lavage with saline, and additional instillation of taurolidine or imipenem/cilastatin in rats with faecal peritonitis. DESIGN: Laboratory study. SETTING: University hospital, The Netherlands. MATERIAL: 60 male Wistar rats. INTERVENTIONS: Rats were given an intraperitoneal injection of a faecal suspension containing Escherichia coli and Bacteroides fragilis. Six groups of 10: sham operation, debridement, debridement with saline lavage, debridement with saline lavage with intraperitoneal instillation of saline or taurolidine, or imipenem/cilastatin, were studied. MAIN OUTCOME MEASURES: Bacterial growth and endotoxin concentration in abdominal exudate and plasma, abscess formation, and mortality. RESULTS: Debridement temporarily reduced bacterial growth and the concentration of endotoxin in abdominal exudate, and delayed mortality. Lavage with saline further reduced bacterial growth and the endotoxin concentration. It also reduced the plasma endotoxin concentration, and mortality. Additional instillation of taurolidine did not reduce bacterial growth, but did initially reduce the endotoxin concentration in abdominal exudate and plasma. Instillation of imipenem/cilastatin, after debridement and lavage, significantly reduced all variables measured. CONCLUSION: In rats with faecal peritonitis, debridement, lavage with saline, and additional instillation of imipenem/cilastatin, all have cumulatively reducing effect on bacterial growth, endotoxin concentrations, abscess formation, and mortality. Instillation of taurolidine reduces only the amount of endotoxin.

Antioxidant levels in the nasal mucosa of patients with chronic sinusitis and healthy controls.

BACKGROUND: Imbalances between oxidant formation and antioxidative defense are associated with the pathogenesis of several chronic inflammatory disorders of the respiratory tract. Therefore, a role of oxidative stress in chronic upper airway tract infections can be anticipated. OBJECTIVE: To determine if patients with chronic sinusitis demonstrate a reduced antioxidative tissue status. DESIGN: The levels of 3 biologically important antioxidants, reduced glutathione and oxidized glutathione, uric acid, and vitamin E, were determined biochemically in mucosal biopsy specimens from the uncinate process of patients with chronic sinusitis and healthy controls. SUBJECTS: Inflamed mucosa samples were obtained from 9 patients with chronic sinusitis during functional endoscopic sinus surgery. Normal mucosa samples were collected from 10 healthy controls during surgery for nasal obstruction. RESULTS: The data (presented as mean +/- SD) show a significant reduction (P < or = .05) of reduced glutathione levels (0.3 +/- 0.1 mumol/g wet weight) and uric acid levels (2.7 +/- 0.4 mumol/g wet weight) in mucosa samples obtained from patients with chronic sinusitis compared with healthy controls (0.6 +/- 0.2 and 3.4 +/- 0.6 mumol/g wet weight, respectively). No difference was found in oxidized glutathione (24 +/- 8 vs 25 +/- 15 nmol/g wet weight) and vitamin E (20.5 +/- 7.9 vs 22.5 +/- 6.9 nmol/g wet weight) levels between both groups. CONCLUSIONS: Decreased levels of both reduced glutathione and uric acid in patients with chronic sinusitis lead to a diminished antioxidant defense, which may be associated with the pathogenesis of upper respiratory tract disorders. The vitamin E level seems less important. This finding may offer perspectives for pharmacotherapeutic intervention with antioxidants.

A method for measuring nitric oxide radical scavenging activity. Scavenging properties of sulfur-containing compounds.

A new method for the quantification of the nitric oxide (.NO) scavenging activity of compounds in aqueous solutions is described using an amperometric .NO sensor. After correction for the spontaneous degradation of .NO, second-order rate kinetics of the scavenging reaction are observe. The rate constant for hemoglobin found with this method is comparable with that found with an established spectrophotometric method. To demonstrate the capability of the method, several sulfur-containing compounds were tested (GSH, GSSG, S-methyl glutathione, N-acetyl cysteine, lipoic acid and dihydrolipoic acid). Of these compounds, only those that contained a thiol group displayed a considerable .NO scavenging activity.

Effect of intraperitoneal antimicrobials on the concentration of bacteria, endotoxin, and tumor necrosis factor in abdominal fluid and plasma in rats.

The efficacy of intraperitoneal instillation of antimicrobial agents in eliminating the bacterial contaminant in patients with generalized peritonitis remains controversial. We determined the effect of intraperitoneal instillation of taurolidine or imipenem on mortality, and on the concentration of bacteria, endotoxin, and tumor necrosis factor (TNF) in rats with intraperitoneally injected bacteria. Thirty rats were inoculated intraperitoneally with two enteric bacterial strains, followed by either taurolidine, saline, or imipenem. Abdominal fluid and blood were analyzed at different time intervals. The survival rate was highest in the imipenem group (p < 0.05). The bacterial concentration in abdominal fluid in the taurolidine and imipenem group was lower than in the saline group (p < 0.005), but the concentration in the imipenem group was lowest (p < 0.005). The endotoxin concentration in abdominal fluid and plasma in the taurolidine group was lower than in the other two groups (p < 0.05). The TNF concentration in abdominal fluid and plasma in the taurolidine group was lower than in the saline group (p < 0.05), whereas the concentration in the imipenem group was higher (p < 0.005). We conclude that topically applied taurolidine in rats with intraperitoneally injected bacteria may have a weak antibacterial effect, and lowered concentrations of endotoxin and TNF. Topically applied imipenem had a profound bactericidal activity but induced endotoxin and TNF release.

Anti-oxidant actions of oxymethazoline and xylomethazoline.

Anti-oxidant actions of oxymethazoline and xylomethazoline were investigated by measuring inhibition of microsomal lipid peroxidation and hydroxyl radical scavenging activity. Oxymethazoline was shown to be a potent inhibitor of lipid peroxidation (IC50 = 4.9 microM at t = 15 min, IC50 = 8.1 microM at t = 30 min), in contrast to xylomethazoline. Both compounds were excellent hydroxyl radical scavengers. Their rate constants (ks = 1.1 x 10(12) M-1 s-1 for oxymethazoline and ks = 4.7 x 10(10) M-1 s-1 for xylomethazoline) exceeded the rate constant of a known powerful scavenger cimetidine (ks = 1.8 x 10(10) M-1 s-1). The difference in inhibiting lipid peroxidation might be explained by the fact that only oxymethazoline has a hydroxy group which can donate a hydrogen atom and terminate the chain reaction of lipid peroxidation. The mechanism of hydroxyl radical scavenging activity is still unclear. Moreover oxymethazoline seems to have a different mode of action in scavenging hydroxyl radicals than xylomethazoline and cimetidine which results in an extremely high rate constant. Because oxidants play a role in tissue damage in inflammation, it was hypothesized that especially oxymethazoline and to a lesser extent xylomethazoline may have an additional beneficial effect, due to their anti-oxidant properties, in the topical treatment of nasal inflammation.