Long-term health-related quality of life of surgically treated pituitary adenoma patients: a descriptive study.

Context. The literature concerning the health-related quality of life (HRQoL) of patients with surgically treated PA is controversial. Objective. To describe the long-term HRQoL of surgically treated patients in all PA classes. Design and subjects. The 15D, a generic HRQoL instrument producing a 15-dimensional profile and a single 15D index score (a difference ≥0.03 on a 0-1 scale is considered clinically important), was used to assess the HRQoL of a 13-year surgical cohort of PA patients in Northern Finland. Results and Conclusion. Nighty-eight eligible consecutive patients with surgically treated PA were studied at an average of 6.3 years after their latest pituitary operation. The average postoperative 15D profiles in patients with non-functioning PA and in acromegalics without GH-suppressive medical treatment were similar to those of the age-standardized general population. However, after this rather long followup, the mean 15D score and the number of statistically significant 15D dimension impairments, compared with those of their reference population, were 0.11 and 9/15, 0.10 and 3/15, and 0.08 and 7/15 for Cushing's disease, acromegalics needing somatostatin analog, and prolactinoma patients, respectively. Hypopituitarism with replacement medication was not associated with impaired HRQoL. The somatostatin-analog-associated HRQoL finding warrants further clinical research.

Survival of amoebae on building materials.

UNLABELLED: Moisture damage and concurrent microbial growth in buildings are associated with adverse health effects among the occupants. However, the causal agents for the symptoms are unclear although microbes are assumed to play a major role. Fungi and bacteria are not the only microbes inhabiting moist building materials; it was recently revealed that amoebae are also present. As amoebae have the potential to harbor many pathogens and to modulate the characteristics of growing microbes, a better appreciation of the growth and survival of amoebae in moisture damage conditions will add to the understanding of their effects on health outcomes. In this study, we investigated the ability of amoebae to survive on six building materials. Furthermore, both aged and unused materials were tested. Amoebae survived on gypsum board and mineral wool for the whole 2 months experiment even without additional sustenance. When sustenance (heat-killed bacteria) was available, aged pine wood and birch wood also allowed their survival. In contrast, amoebae were quickly killed on fresh pine wood and they did not survive on concrete or linoleum. In conclusion, our data show that amoebae can persist on several common building materials once these materials become wet. PRACTICAL IMPLICATIONS: Amoebae are able to survive on many building materials should the materials become wet. Amoebae have the potential to increase growth, cytotoxicity, and pathogenicity of other microbes present in moisture damages, and they may carry potentially pathogenic bacteria as endosymbionts and thus introduce them into the indoor air. Therefore, amoebae may have a prominent role in the microbial exposures occurring in moisture-damaged buildings. The presence of amoebae could be usefully included in reporting the microbial damage of material samples.

MR of a nasal glioma in a young infant.

We describe MR findings of a nasal glioma in a 5-week-old male infant with feeding difficulties and symptoms of respiratory distress. Endoscopic examination revealed a soft tissue mass in the nasal cavity. In T1- and T2-weighted images, the gyral structure of grey matter was visible. In T1-weighted images, a tissue component with a lower signal intensity equal to that of white matter was also well distinguishable. Edge enhancement of the tumour was due to the nasal mucosal epithelium covering the tumour. MR images were useful to rule out intracranial extension of the nasal cavity lesion and the brain, thus excluding the diagnosis of encephalocele. The lesion was excised and histologically characterized as heterotopic brain tissue.

Unilateral and bilateral effects of nasal septum surgery demonstrated with acoustic rhinometry, rhinomanometry, and subjective assessment.

Little is known of what happens after an operative correction of nasal septum deviation in the cavity contralateral to the major septum deviation. We studied the effects of septoplasty on the objective and subjective unilateral and bilateral nasal airway in 117 consecutive patients presenting for septoplasty due to a clinically obstructing septum deviation. Significant median increases in nasal flow and cross-sectional areas were noted postoperatively on the deviation side, whereas on the contralateral side the nasal flow and the cross-sectional area at the nasal valve (MCA1) decreased significantly, the median decreases being 19% (p = 0.022) in the flow and 22% (p = 0.0001) in MCA1 before decongestion and correspondingly 22% (p = 0.004) and 21% (p = 0.0001) after decongestion. Only slight median increases were noted in the bilateral assessment postoperatively in these parameters. In the subjective assessment 40% of patients were totally free from nasal obstruction postoperatively and the sensation of obstruction was low in 35%. An inverse correlation was found between the postoperative satisfaction and the decrease in MCA1 on the wide side (r = -0.21, p = 0.03) and positive correlations between the postoperative satisfaction and the increase in MCA1 on the deviation side (r = 0.26, p = 0.0042) and with the bilateral increase in MCA1 (r = 0.20, p = 0.02). The preoperative subjective sensation of nasal obstruction correlated significantly with the objective parameters on the deviation side, but not with the bilateral parameters. In conclusion, it was demonstrated with an objective and subjective assessment that correction of a septum deviation may induce harmful effects to the valve area on the side contralateral to a deviation. However, postoperatively the overall relief of nasal obstruction was good and the satisfaction high in most patients.

Preoperative virtual endoscopy and three-dimensional imaging of the surface landmarks of the internal carotid arteries in trans-sphenoidal pituitary surgery.

In trans-sphenoidal pituitary adenoma surgery the sella turcica is opened between the internal carotid arteries. Three-dimensional image processing methods were applied in this study to avoid the risk of damaging the arteries during the opening of the anterior wall of the sella. By using graphical software it was possible to combine the anatomies of the carotid arteries and the sellar wall into one non-perspective three-dimensional image. With a perspective image (virtual endoscopy), the sphenoid sinus landmarks were presented as if looking through a nasoendoscope. This also facilitated preoperative planning but the non-perspective images, with the carotid arteries marked, were found to be the most useful and suitable for clinical routine. The pituitary tumor itself and its relations with the adjacent structures were best evaluated from magnetic resonance imaging scans but, for the opening of the sellar wall and in the three-dimensional orientation with endoscopy, three-dimensional computerized tomography imaging with the carotid arteries marked was found to be helpful.

Acute epiglottitis in northern Finland today--still a potential emergency situation.

To examine patient characteristics related to airway intervention in acute epiglottitis and how the intervention affected the further course of the disease, 46 pediatric and 49 adult cases were retrospectively evaluated. All three airway management approaches, namely observation, nasotracheal intubation and tracheotomy were needed in both the children and adults. Five out of every six children needed an artificial airway, while observation was sufficient in three out of every five adults. H influenzae type b bacteremia in children, a short duration of the symptoms in adults and most important, respiratory distress in both were the best predictors of the need for an artificial airway. Nasotracheal intubation may be a successful means of implementing an artificial airway, but it is a technically demanding procedure and complications are frequent. Despite the recent changes in the occurrence of acute epiglottitis it remains a potential emergency situation both in children and adults.

Acoustic rhinometry, rhinomanometry and the amount of nasal secretion in the clinical monitoring of the nasal provocation test.

BACKGROUND: The reliable interpretation of the nasal provocation test in allergy diagnosis requires objective and measurable monitoring parameters for clinical practice. The clinical usefulness of the nasal provocation test has been limited by scanty knowledge of the specificity and sensitivity of the test and a lack of reference values. OBJECTIVE: To test and compare three objective monitoring parameters of a nasal provocation test in occupational allergic rhinitis. To evaluate the magnitude of the nasonasal effects in a unilateral allergen challenge. METHODS: The monitoring parameters of the nasal reaction were derived from the minimum cross-sectional area on acoustic rhinometry, the nasal resistance on active anterior rhinomanometry and the amount of nasal secretion measured at 15 min intervals for 60 min. Twenty-three bovine-allergic dairy and beef cattle farmers and 19 exposed, non-allergic control subjects were challenged first with a control solution and then with the cow allergen. RESULTS: All the three monitoring parameters showed high specificity and sensitivity in finding allergic and non-allergic subjects. The secretion parameter was found to be slightly superior to the acoustic rhinometry and rhinomanometry parameters. The side difference in the nasal response between the allergen-challenged and the contralateral diluent-challenged cavity was significant for all the parameters among the allergic subjects. The contralateral secretion amount was 1/3 of the ipsilateral secretion, indicating the magnitude of the contralateral nasonasal reflex. A nasonasal reflex was also noted in the nasal patency monitoring. The coefficient of variation was significantly lower for the acoustic rhinometry than for the rhinomanometry (P=0.0001). The optimal threshold values for a positive test were a secretion amount of 100 mg, a 15% decrease in the minimum cross-sectional area and a 50% increase in the resistance for the observation period of 30 min and correspondingly 210 mg, 30% and 100% for 60 min. CONCLUSION: The low-pressure aspiration of the nasal secretion from the anterior part of the nasal cavity was found to be a reliable and practical monitoring parameter to be used together with acoustic rhinometry or rhinomanometry in the nasal provocation test for clinical purposes. Although significant nasonasal effects took place in the unilateral allergen challenge, the response was more prominent in the allergen-challenged than in the contralateral diluent-challenged nasal cavity in most allergic subjects.

Physiological fluctuations in nasal resistance may interfere with nasal monitoring in the nasal provocation test.

The physiological fluctuations in nasal flow and resistance in allergic subjects were studied by monitoring 12 subjects with perennial occupational allergic rhinitis with active anterior rhinomanometry (AAR) for 3 h at 15 min intervals. The subjects were then challenged bilaterally with the diluent solution for allergen extracts and the effect was monitored with AAR. In AAR. cellular rubber nose adapters were used. Many physiological fluctuations in nasal patency were observed. Reference intervals were calculated for the changes in flow and resistance at the gradient pressure of 150 pa. For example, a 100% increase in unilateral resistance was found to be significant at the risk level of 5-10% for the observation time of 30-60 min. The corresponding increase for bilateral resistance was close to 70%. Challenge with diluent solution had a negliglible effect on the resistance fluctuation, the reference intervals being close to those for baseline monitoring. In conclusion, rapid changes in nasal flow and resistance in allergic subjects were common, and caution is necessary when interpreting these changes as a positive nasal reaction in the nasal provocation test. In addition, the use of other objective parameters, such as the amount of nasal secretion is recommended.

Latex-induced allergic rhinitis in a laboratory nurse.

A case of occupational rhinitis in association with natural rubber latex hypersensitivity is presented. In the nasal provocation test for natural rubber latex glove powder the nurse experienced rhinorrhoea. A significant increase in the amount of nasal secretion and mucosal oedema could be detected. The patient also showed a positive skin prick test to natural rubber latex allergens, and an elevated natural rubber specific IgE level in her serum. This, to our knowledge, has not been previously reported in the literature.

Perforation in hypopharynx and deep cervical emphysema caused by blunt external trauma.

We present a case in which a blunt external trauma caused a perforating wound in the hypopharynx without any superficial damage on the skin of the neck. Deep cervical emphysema and general signs of systemic infection followed. The wound was sutured through an endoscope and the patient recovered uneventfully. The importance of the early diagnosis is emphasized.

Acute epiglottitis and infant conjugate Haemophilus influenzae type b vaccination in northern Finland.

OBJECTIVE: To determine the incidence and characteristics of acute epiglottitis among children (< or = 19 years of age) and adults (> or = 20 years of age) before and after widespread conjugate Haemophilus influenzae type b vaccination for infants. DESIGN: A retrospective population-based survey over a 27-year period from 1967 through 1993 in 35 communities in a northern province of Finland with a population of approximately 300,000. SETTING: An academic tertiary referral center. MAIN OUTCOME MEASURES: All acute epiglottitis cases in the area identified from the hospital discharge register and the regional autopsy register. RESULTS: The average incidence rate for children was 1.8 cases per 100,000 individuals per year (95% confidence interval [CI], 1.3 to 2.5). As no vaccine failures emerged, the incidence rate for children aged 0 to 4 years declined sharply once the vaccination started in 1986 from 7.6 (95% CI, 5.3 to 10.4) to 0 (95% CI, 0 to 3.3) cases per 100,000 individuals per year. By contrast, a fourfold increase in adult acute epiglottitis (incidence rate ratio, 4.6; 95% CI, 2.7 to 7.9) was detected after vaccination of the children, the average incidence rate for the whole period being 1.0 cases per 100,000 individuals per year (95% CI, 0.8 to 1.3). No marked change in the adult patient profile was found during this increase, however. CONCLUSION: Acute epiglottitis practically vanished among young children in this population after conjugate H influenzae vaccination, but adult cases increased, the patient profile remaining the same.

Sinus aspirates and radiographic abnormalities in severe attacks of asthma.

We evaluated the occurrence of abnormalities in paranasal sinus radiographs in acute asthma by taking a radiograph of the sinuses of 110 consecutive patients admitted to a medical ward a total of 149 times for asthma. Maxillary sinus infection was assessed by taking aspirate from radiologically abnormal maxillary sinuses. An abnormal finding in any paranasal sinus was detected on 87% (130 of 149) of admissions and the yield of maxillary aspirate was macroscopically mucous, purulent or mucopurulent in 60% (42 of 70) of aspirates. A positive bacteriological culture was obtained from 23 aspirates and a virus was detected in 15, there being 7 aspirates in which both a bacterium and a virus could be detected. Although the correlation between radiographic findings and the aspirates was not very close we conclude that radiographic abnormalities of the paranasal sinuses are common in acute asthma as are infections of maxillary sinuses with an abnormal radiographic finding. There is an obvious need to look for sinusitis when a patient with an exacerbation of asthma is being evaluated.

Left-right asymmetries in hearing threshold levels in three age groups of a random population.

The average asymmetry between the hearing threshold levels in the left and right ears was analyzed in a random population (n = 3487) representing a normal population. Males and females of age groups 5-10 years, 15-50 years and over 50 years were analyzed separately. A significant average inferiority of the hearing in the left ear was found at high frequencies, especially at 3-6 kHz, among adult males and females but not among children. A slight but statistically significant average superiority of the left ear at low frequencies was noted in all age groups. At corresponding hearing threshold levels at 4 kHz, the average inferiority of the left ear in the male population was significantly greater among subjects aged 15-50 years than among older subjects. In conclusion, the inferiority of hearing in the left ear at 4 kHz seems to be associated more with noise damage than with presbyacusis. The average interaural difference at 4 kHz was significantly more marked among subjects aged 15-50 years than among older subjects when analyzed at the corresponding threshold levels. These findings indicate a pathophysiological difference between noise damage and presbyacusis.

Left-right asymmetry in the human response to experimental noise exposure. I. Interaural correlation of the temporary threshold shift at 4 kHz frequency.

Most epidemiological surveys concerning populations exposed to occupational noise or random populations have shown that the left ear is slightly but significantly poorer than the right ear, especially at frequencies most susceptible to noise damage. To experimentally study the possible left-right asymmetry in response to noise exposure, 28 non-shooting healthy young adults were exposed binaurally to symmetrical broad-band noise for a maximum of 8 h. 4 kHz hearing thresholds of each individual were monitored alternately in the left and right ears during short interruptions in the exposure. Considerable efforts were made to exclude any external factors that might influence the left-right asymmetry. A significant positive correlation between the temporary threshold shifts (TTS) in the left and in the right ear was found. The average TTS was higher in the left than in the right ear, the difference between ears being statistically indicative.

Left-right asymmetry in the human response to experimental noise exposure. II. Pre-exposure hearing threshold and temporary threshold shift at 4 kHz frequency.

The repeatedly noted average inferiority of the left ear (or superiority of the right ear) in epidemiological surveys at frequencies most susceptible to noise damage has not been experimentally confirmed. Twenty-eight non-shooting young adults were exposed binaurally to broad-band noise for a maximum of 8 h in strictly symmetrical laboratory conditions. The left and right hearing thresholds of each individual were monitored during short interruptions in the exposure. The average interaural hearing threshold difference became statistically significant during the exposure, the left ear being worse than right. The negative correlation found between the pre-exposure threshold level and the temporary threshold shift (TTS) was more marked in the left than in the right ear. In conclusion a hypothesis is presented: a good hearing threshold level in the right ear seems to be better protected from noise-induced temporary threshold shift than a good hearing threshold in the left ear.

Hearing asymmetry among occupationally noise-exposed men and women under 60 years of age.

Interaural asymmetry of hearing thresholds at 4 kHz was analysed in four populations exposed to occupational noise. The left ear was found to be on average significantly worse than the right ear, among both the male and female subjects. In the male population the left ear was twice as often the worse ear as the right one. In the female population the corresponding ratio was 1.5. The average inferiority of the left ear increased as a function of the hearing threshold level. Among subjects with abundant shooting (reindeer herders) the average inferiority of the left ear was close to the average of all male subjects. Interaural difference increased as a function of the hearing threshold level, both among subjects with the left ear and subjects with the right ear being the worse one. In the male population the interaural difference was significantly greater in the former than in the latter group of subjects.

Hearing asymmetry among left-handed and right-handed persons in a random population.

The possible effect of handedness on hearing threshold asymmetry was analysed in a large random population representing a normal population. The left ear was on an average slightly but significantly poorer than the right ear at high frequencies, especially at 4 kHz, while at low frequencies the right ear was on average poorer than the left ear. A matched control group of the right-handed subjects was formed for 211 left-handed subjects. Among the left-handed subjects the average ear asymmetry resembled the ear asymmetry of the whole population, the right-handed subpopulation, and of the matched control group. In conclusion, it seems that handedness cannot be responsible for the average inferiority of hearing in the left ear at 4-kHz or for the average slight superiority of the left ear at 0.125-0.5 kHz. However, this analysis does not rule out possible minor effects of handedness on ear asymmetry.