Case of progressive facial hemiatrophy with cervical sympathetic hyperactivity as underlying aetiology.

OBJECTIVE: We report a case of progressive facial hemiatrophy with cervical sympathetic hyperactivity as a possible underlying aetiology, based on clinical findings, three-dimensional computed tomography and thermographic imaging. METHODS: We present a case report in which we describe the investigation and clinical course of progressive facial hemiatrophy, and we also review the world literature on this condition. RESULTS: To our knowledge, this is the first report in the world literature of progressive facial hemiatrophy with cervical sympathetic hyperactivity indicated as a possible underlying aetiology, based on clinical findings, three-dimensional computed tomography and thermographic imaging. CONCLUSION: This syndrome may lead to atrophy of the subcutaneous adipose tissue with hyperfunction of the vegetative system. Although this is a rare syndrome, otolaryngologists should be aware of its symptoms, aetiology and treatment.

Effects of low-dose aspirin on endothelial function in hypertensive patients.

BACKGROUND: It has been reported that administration of low-dose aspirin significantly reduces the frequency of major cardiovascular events in patients with hypertension and coronary artery disease. It is generally considered that the preventative effects of long-term aspirin administration on major cardiovascular events are due to the inhibition of platelet aggregation. HYPOTHESIS: It is not known whether administration of low-dose aspirin restores endothelium-dependent vasodilatation, and this study was undertaken to prove or disprove this question in patients with hypertension. METHODS: Flow-mediated endothelium-dependent dilatation and glyceryl trinitrate-induced endothelium-independent dilatation were investigated in 18 hypertensive patients and 10 normotensive control subjects. In the hypertensive patients, flow-mediated dilatation was investigated and cyclic guanosine monophosphate plasma (cGMP) was measured before and at 8 weeks after the administration of 162 mg of aspirin. RESULTS: Flow-mediated dilatation before aspirin administration was more reduced in the hypertensive patients than in the control subjects (6.4+/-2.0% vs. 11.3+/-2.3%, p <0.0001). Glyceryl trinitrate-induced dilatation before aspirin administration was similar in hypertensive patients and control subjects. Flow-mediated dilatation after aspirin administration was improved compared with that before aspirin administration (10.4+/-3.5% vs. 6.4+/-2.0%, p<0.0004). The cGMP product after aspirin administration was significantly higher than that before aspirin administration. CONCLUSIONS: Administration of low-dose aspirin may restore the endothelium-dependent vasodilatation in hypertensive patients. Furthermore, increased nitric oxide production may play a partial role in the improvement in endothelial function induced by administration of low-dose aspirin.

The outcome of the canalith repositioning procedure for benign paroxysmal positional vertigo: are there any characteristic features of treatment failure cases?

To demonstrate the success rate of the canalith repositioning procedure (CRP) in our clinic and to establish any characteristic features of cases of treatment failure, we reviewed clinical records of 62 patients who were diagnosed with posterior semicircular canal-benign paroxysmal positional vertigo (BPPV) and treated with the CRP. The basic strategy of the CRP was to rotate the involved canal slowly in the plane of gravity so that free-floating materials could migrate into the utricle only once. After the procedure we instructed patients to keep their heads upright for 10 h and not to sleep on the affected ear for 2 weeks. After the initial treatment, successful results were obtained in 51 of the 62 patients (82.2%). After the second treatment, 56 patients (90.3%) experienced success. Six patients (9.7%) did not obtain resolution even after the second treatment. While 46 patients were diagnosed with idiopathic BPPV, in 16 patients a different diagnosis was determined (head injury in 7 patients, Ménière's disease in 2, vestibular neuritis in 2 and unilateral sensorineural hearing loss in 5). We categorized these 16 patients as having secondary BPPV. Patients with idiopathic BPPV showed a significantly higher success rate with CRP than those with secondary BPPV. Patients with secondary BPPV may have quantitatively or qualitatively different lesions than those with idiopathic BPPV.