Emergency drug usage during flight and airline safety management for passengers.

During flight, passengers may experience aviation-related symptoms such as headache, nausea, respiratory failure, and panic disorders. To treat patients with these symptoms, emergency drugs are prepared in the cabin and crews treat patients according taking into account usage and dose guidelines described on the drug containers. However, certain types of drugs are limited and not adequately prepared in the cabin. The aim of this study was to examine (1) emergency drugs used during flight and frequency of symptoms experienced in passengers and (2) cognizance of drug usage among crews was also determined in low-cost carriers. Most frequent symptoms recorded were headache (74.1%), abdominal pain (72.3%), nausea (70.5%), and ear pain (60.7%). Panic disorder (50.9%) is the fifth frequent syndrome in passengers, but emergency drugs are not available for this condition in the cabin. The cognizance survey showed that 21% of crews out of 112 who responded were not interested in usage guidelines of emergency drugs or simply ignored. Thirty-seven percent of crews failed to pay attention to drug expiration dates. Our findings suggest that crews need to be better trained for preparation and usage of emergency drugs in the cabin for passengers suffering from various symptoms. Further, it is recommended that airline companies need to consider to improve the emergency drug management system by requesting training from pharmacists and doctors for safe drug usage.

Fungus Ball of the Maxillary Sinus Presenting With Epiphora.

The authors report a case of fungus ball of the maxillary sinus with bone erosion presenting with epiphora, which was diagnosed after treatment failure using silicone intubation for nasolacrimal duct obstruction. Symptoms of sinus fungus ball are similar to those of chronic bacterial rhinosinusitis, although occasionally asymptomatic. To our knowledge, epiphora has never been reported as a symptom of sinus fungus ball. The purpose of this report is to emphasize the importance of considering sinonasal causes when evaluating epiphora patients, as well as to suggest the use of preoperative CT scans for a more accurate diagnosis and to prevent unnecessary procedures.

Down-regulation of gelsolin may play a role in the progression of inverted papilloma through an antiapoptotic mechanism.

BACKGROUND: Gelsolin is an actin-binding protein with multiple cellular functions including apoptosis and is reported to be down-regulated in various cancers and premalignant lesions. The objective of this study was to identify gelsolin and caspase-3 expression in inverted papilloma (IP) and investigate the role of gelsolin in the progression of IP related to apoptosis. METHODS: Specimens from 30 patients with nondysplastic IP were retrieved. The percentage of surface epithelium covered with squamous metaplastic epithelium was assessed. Immunohistochemically demonstrated gelsolin and caspase-3 expression were compared between IP and adjacent control mucosa. We analyzed the correlations among gelsolin expression, caspase-3 expression, and the degree of squamous metaplasia in IP. RESULTS: The degree of squamous metaplasia of surface epithelium was inversely correlated with gelsolin (r = -0.610; p < 0.001) and caspase-3 expression (r = -0.433; p = 0.017). Gelsolin expression in IP was significantly lower than that in the control when >50% of surface epithelium showed squamous metaplasia (p = 0.015). Caspase-3 also showed diminished expression when >50% of surface epithelium had undergone squamous metaplasia (p = 0.035). Gelsolin and caspase-3 expression showed no significant differences when the degree of squamous metaplasia was ≤50%. Gelsolin and caspase-3 expression levels in IP had a positive relationship (r = 0.557; p = 0.001). CONCLUSION: Progression of IP may be related to an insidious decrease in caspase-3-mediated apoptosis, and down-regulated gelsolin expression may be correlated with the decrease in apoptosis, especially in more highly progressed IP in which >50% of surface epithelium has undergone squamous metaplasia.

Three-dimensional reconstruction based on images from spiral high-resolution computed tomography of the temporal bone: anatomy and clinical application.

The aim of this study was to investigate the usefulness of a three-dimensional (3D) reconstruction of computed tomography (CT) images in determining the anatomy and topographic relationship between various important structures. Using 40 ears from 20 patients with various otological diseases, a 3D reconstruction based on the image data from spiral high-resolution CT was performed by segmentation, volume-rendering and surface-rendering algorithms on a personal computer. The 3D display of the middle and inner ear structures was demonstrated in detail. Computer-assisted measurements, many of which could not be easily measured in vivo, of the reconstructed structures provided accurate anatomic details that improved the surgeon's understanding of spatial relationships. A 3D reconstruction of temporal bone CT might be useful for education and increasing understanding of the anatomical structures of the temporal bone. However, it will be necessary to confirm the correlation between the 3D reconstructed images and histological sections through a validation study.