Evaluation of the Relationship Between Nasal Septum Deviation and Oxidative Stress Markers.

INTRODUCTION: Nasal septum deviation (NSD) may lead to chronic hypoxia and increased oxidative stress.The main goal of this study was to investigate the effect of NSD on malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), and glutathione (GSH) levels. METHODS: There were 30 patients with NSD and 30 healthy subjects in this study. Malondialdehyde, CAT, SOD, and GSH levels were determined in the control and study groups. The measurements were done preoperatively and postoperatively. Study group patients completed the Nasal Obstruction Symptom Evaluation questionnaire preoperatively and postoperatively to determine the success of the septoplasty. RESULTS: Higher CAT, SOD, and GSH levels and lower MDA levels were found in the control group compared with the study group (P < 0.05). After septoplasty, Nasal Obstruction Symptom Evaluation scores improved significantly and CAT, SOD, and GSH levels increased significantly (all, P < 0.05). Malondialdehyde levels did not decrease significantly after surgery (P > 0.05). CONCLUSIONS: Nasal obstruction due to nasal septal deviation led to lower antioxidant enzyme levels, and correction of the septum led to an increase in antioxidant levels.

Nasal obstruction during adolescence induces memory/learning impairments associated with BDNF/TrkB signaling pathway hypofunction and high corticosterone levels.

The hippocampus is an important brain region involved in memory and learning. Brain-derived neurotrophic factor (BDNF), tyrosine kinase receptor B (TrkB), and phospho-p44/p42 mitogen-activated protein kinase (MAPK) are known to contribute to hippocampal memory/learning. The present study aimed to clarify the effects of nasal obstruction during the growth period on memory/learning in an animal model, using combined behavioral, biochemical, and histological approaches. Male BALB/C mice underwent unilateral nasal obstruction (UNO) by cauterization at 8 days of age and were subjected to Y-maze and passive avoidance tests at 15 weeks of age. The serum corticosterone levels were measured using an enzyme-linked immunosorbent assay, and brain tissues were subjected to hematoxylin-eosin staining and histological analysis or homogenization and Western blot analysis. Compared with control mice, UNO mice had lower blood oxygen saturation levels and exhibited apparent memory/learning impairments during behavioral testing. Additionally, the UNO group had higher hippocampal BDNF levels and serum corticosterone levels, lower hippocampal TrkB and phospho-p44/p42 MAPK levels, and reduced neuron numbers relative to controls. Our findings suggest that UNO during adolescence affects the hippocampus and causes memory/learning impairments.

The effects of septoplasty surgery on serum oxidative stress levels.

The aim of this study is to compare the total antioxidant status (TAS), total oxidant status (TOS), and paraoxonase (PON1) serum levels in patients who have undergone septoplasty (NSD). Forty-six patients (mean age 33.7) aged between 18 and 50 years who were diagnosed with nasal septal deviation (NSD) were included in the study. The TAS, TOS, and PON1 levels were compared in the serum samples obtained 1 month before the septoplasty and 3 months after surgery. There was a significant increase in mean TAS after septoplasty (1.041 vs. 1.124 mmol/L, p = 0.011). The mean TOS decreased significantly after septoplasty (20.631 vs. 5.946 mmol/L, p = 0.011). The mean pre- and postoperative PON1 levels were similar (326.93 ± 215.22 vs. 275.20 ± 167.76 U/L, p = 0.253). Increased TAS and decreased TOS after septoplasty show that patients with NSD are under oxidative stress that is relieved following septoplasty.

Severe brachycephalic obstructive airway syndrome is associated with hypercoagulability in dogs.

We evaluated whether dogs with severe brachycephalic obstructive airway syndrome (BOAS) developed a hypercoagulable state similar to people with obstructive sleep apnea. Five dogs with grade 3 BOAS were included as well as 5 healthy control Labrador Retrievers. Venous blood samples were collected from each dog for performance of thromboelastography and determination of hematocrit and platelet count. Groups were compared using a t-test, with p < 0.05 considered significant. Thromboelastography results identified that all BOAS dogs were hypercoagulable compared to the Labradors, having significantly shortened clotting time with increased angle, maximal amplitude, and clot rigidity. BOAS dogs also had evidence of delayed fibrinolysis. These results are consistent with, but more severe than, those previously documented in apparently healthy Bulldogs. Together, these findings support the presence of a hypercoagulable state in brachycephalic dogs, and suggest that this state is amplified by increasing severity of BOAS.

Changes at Mean Platelet Volume and Platelet Distribution Width Levels After Septoplasty and Its Correlation With Epworth Sleepness Scale.

OBJECTIVE: Nasal septum deviation may affect cardiopulmonary system. Those effects can be determined via blood tests and Epworth sleepness scale (ESS). In this study, it was aimed to measure mean platelet volume (MPV) and platelet distribution width (PDW) in patients with nasal septum deviation and to assess changes at their levels after septoplasty. Furthermore, it was purposed to document the correlation between ESS score and MPV, PDW levels. METHODS: Eighty-one patients who underwent septoplasty and 50 healthy controls composed the study group. Epworth sleepness scale was performed to all patients preoperatively and patients were divided into 2 groups in terms of ESS scores. Mean platelet volume and PDW levels were measured preoperatively and it was repeated postoperatively. RESULTS: In Group A (ESS <10), MPV reduced from 8.48 ±â€Š0.38 fl to 8.47 ±â€Š0.36 fl (P >0.05), PDW reduced from 14.56 ±â€Š1.27% to 14.43 ±â€Š1.03% after surgery (P >0.05). On the other hand, in Group B (ESS ≥10), MPV reduced from 9.54 ±â€Š0.68 fl to 8.87 ±â€Š0.44 fl (P <0.001), PDW reduced from 17.15 ±â€Š1.75% to 15.35 ±â€Š1.29% postoperatively (P <0.001). CONCLUSIONS: Statistically significant improvements at MPV and PDW levels after surgery were noticed only at patients with excessive daytime sleepness whose ESS score was 10 or above. According to this, it would be preferable to operate these patients earlier to protect them from systemic effects.

Effects of Bilateral Nasal Packing on Oxygen Saturation and Blood Pressure.

INTRODUCTION: Nasal packing is one of the most common rhinological procedures in ENT practice exerting local in nose and systemic effects. Systemic effects may be due to poor sleep quality, respiratory difficulty, decreased oxygen saturation, circulatory problems and toxic shock syndrome which can threaten the life of a person.The study was done to investigate the effect on bilateral nasal packing on blood oxygen saturation and blood pressure changes. METHODS: A cross-sectional prospective study was undertaken in Kathmandu Medical College from January 2017 to June 2017. The ethical approval was taken from institutional review committee of KMC and verbal consent was taken from each patient. Thirty patients were included in the study by simple randomized sampling. The association between nasal packing and oxygen saturation and blood pressure was done using ANNOVA and Fisher Exact test. P value of <0.005 was considered statistically significant. SPSS version 20 for windows OS was used for analysis. RESULTS: Blood oxygen saturation on four different days was compared using ANNOVA and paired sample tests. It showed a significant dip on the day of bilateral nasal packing compared to other readings (P value <0.001). Likewise, systolic and diastolic blood pressures showed a significant rise on the day of bilateral nasal packing compared to readings on other days (P value <0.001). CONCLUSIONS: Bilateral nasal packing can lead to significant rise in systolic and diastolic blood pressure and a dip in blood oxygen saturation. Thus care has to be taken while performing bilateral nasal packing in normal patients but much more in high risk patients.

The effect of duration of nasal obstruction on mean platelet volume in patients with marked nasal septal deviation.

Nasal obstruction is a common cause of marked nasal septal deviation. It is related strongly with hypoxia. Hypoxic conditions increase mean platelet volume levels. This study aimed to investigate the effect of age on mean platelet volume in patients with marked nasal septal deviation. We made a retrospective study of patients with marked nasal septal deviation between January 2012 and May 2014. The patients were divided into four groups according to duration of nasal obstruction (less than 10, 10-20, 20-30 and more than 30 years). The groups were compared with each other in terms of mean platelet volume, platelet distribution width, platelet count in preoperative hemogram. This study was performed on 356 male and 139 female patients. Mean age was 33.9 ± 12.3 years. It was determined that the platelet count, mean platelet volume did not constitute statistically significant difference between groups (p > 0.05). Nevertheless, it was determined that as the duration of nasal obstruction elongated the mean platelet volume value increased and platelet count values decreased. Mean values of platelet distribution width constituted statistically significant difference between all groups (p = 0.026). Patients with marked nasal septum deviation should be subjected to surgery as soon as possible because of the increase in mean platelet volume and platelet distribution width values which are related to increase in the risk of cardiopulmonary complications of nasal obstruction.

Albumin Levels in Patients With Chronic Rhinosinusitis With Nasal Polyp.

OBJECTIVES: We aim to provide useful evidence on the relationship between the albumin levels and chronic rhinosinusitis with nasal polyp (CRSwNP) and its potential use as an inexpensive, reliable, and independent prognostic marker of CRSwNP. MATERIALS AND METHODS: Forty-five patients with CRSwNP and 45 healthy individuals were included in the study. Serum albumin levels were determined. The serum albumin levels of the study and control groups were compared to determine whether there is a statistically significant difference. RESULTS: The mean albumin level of the study group was 4.65 ±â€Š0.38, the median value was 4.70. The mean albumin level of the control group was 4.84 ±â€Š0.39, the median value was 4.90. There was a statistically significant difference between the albumin levels of the study and control groups (P = 0.045, P < 0.05). CONCLUSION: The albumin levels were found to be statistically significantly lower in patients with CRSwNP. This result may contribute to the diagnosis of CRSwNP and identifying its prognosis.

Mean platelet volume levels in children with adenoid hypertrophy.

Adenoid hypertrophy (AH) is a common disorder in children, resulting in chronic nasal congestion. This chronic congestion should be evaluated carefully because it can lead to chronic upper airway obstruction. Many authors have suggested that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of cardiopulmonary diseases. Mean platelet volume (MPV) is a marker of platelet function and is positively associated with indicators of platelet activity. Mean platelet volume is an indicator of larger and more reactive platelets and has been shown to be increased in patients with vascular disease, including peripheral, pulmonary, and coronary artery disease. Recently, MPV levels have also been shown to be increased in patients with severe obstructive sleep apnea, and marked nasal septal deviation. Moreover, increased MPV has also been shown to have a prognostic role in cardiovascular disease. We investigated whether MPV is higher in patients with AH and whether higher MPV levels can be reduced by adenoidectomy. To the best of our knowledge, this is the first study to investigate MPV in patients with AH. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with AH and adenoidectomy is an effective therapeutic measure in such patients. Increased platelet activation may be related to an increase of cardiopulmonary risk in patients with AH.

[Analysis the relationship of mean platelet volume and nasal obstructive disease].

OBJECTIVE: High mean platelet volume (MPV) values are a risk factor for cardiovascular diseases. Our aim was to investigate the association between nasal obstructive disease and MPV value. METHOD: This study included 40 patients with nasal obstructive disease and 30 age-and sex-matched healthy subjects as controls. The levels of the number of platelets, MPV, platelet distribution width (PDW) were evaluated and compared in the two groups. Then the MPV was compared in the patients before and after operation in the study group. RESULT: Platelet count is significantly lower in the study group than the control group [(215.0 ± 47.5) x 10(9)/L versus (237.8 ± 46.2) x 10(9)/L]; MPV and PDW is significantly higher in the study group [(10.7 ± 0.7) fL versus (10.3 ± 0.8) fL]; [(12.9 ± 2.0) % versus (12.0 ± 1.3) %]. Comparing to preoperation, MPV values of the study group is significantly decreased after nasal obstructive operations [(10.7 ± 0.7) fL versus (10.4 ± 0.6) fL]. CONCLUSION: MPV levels are elevated in patients with nasal obstructive disease, and can be decreased by nasal obstructive operation.

Impact of septoplasty on mean platelet volume levels in patients with marked nasal septal deviation.

Nasal septal deviation (NSD) is a very common cause of recurrent and chronic nasal obstruction. Chronic nasal obstruction leads to increased upper respiratory tract resistance, and also upper respiratory tract resistance leads to chronic hypoxia and hypercarbic because of alveolar hypoventilation. Chronic hypoxia and hypercarbia show tendency for hypercoagulopathy.Mean platelet volume (MPV), the most commonly used measure of platelet size, is a potential marker of platelet reactivity. Large platelets that contain more dense granules are enzymatically and metabolically more active and have greater prothrombotic potential. In previous studies, increased MPV was demonstrated in hypertension, unstable angina pectoris, myocardial infarction, stroke, and obstructive sleep apnea.We aimed to determine whether MPV levels are elevated in patients with marked NSD (MNSD) compared with healthy controls. In addition, we tried to find out the effect of nasal septoplasty on MPV levels. We found that the MPV levels were significantly higher in the MNSD group than in the control healthy group, and also we found that MPV levels were significantly decreased in the MNSD group after septoplasty operation.In conclusion, in our knowledge, this is the first study investigating MPV levels in patients with MNSD. Increased platelet activation may be related to increase the cardiovascular risk in patients with MNSD. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with MNSD, and the increase in MPV levels of the cases with MNSD could be treated by septoplasty.

[General oxygen supply in males with rhonchopathy].

Supply, transport and release of oxygen in tissues were studied in 100 patients with rhonchopathy. Blood was obtained from the lobe of the ear and was examined on the gas analyzer (348 model). The results of the study show that respiratory hypoxemia is characteristic for rhonchopathy, hypoxemia is compensated with gemic factors, nocturnal hypoxemia leads to hypoxia in 7% patients with rhonchopathy.

The impact of postoperative nasal packing on sleep-disordered breathing and nocturnal oxygen saturation in patients with obstructive sleep apnea syndrome.

Nasal septum surgery is frequently performed to establish a functional nasal airway. In these patients obstructive sleep apnea syndrome (OSAS) is frequently present. Although patients with OSAS are at increased risk for hypoxemia, the impact of postoperative nasal packing (PNP) on sleep-disordered breathing and oxygen desaturations in patients with OSAS is unknown. We consecutively investigated 40 patients undergoing endonasal surgery receiving PNP. Fifteen of these patients had previously diagnosed OSAS (Group 2) and 25 did not (Group 1). In the control group, 12 healthy patients underwent elective ear or neck surgery without PNP. During the preoperative and postoperative nights, we continuously measured oronasal flow, thoracoabdominal movements, and oxygen saturation. We calculated the apnea-hypopnea index (AHI) and the oxygen-desaturation index (ODI). Compared with the preoperative values, after the operation, neither AHI nor ODI changed in the control group. In contrast, in Group 1, AHI (from 11 [5-19] to 37 [22-49]) and ODI (from 4 [2-8] to 13 [6-21]) significantly increased (P < 0.05), whereas in Group 2, only AHI significantly increased (from 14 [10-21] to 39 [26-50]); ODI remained similar (13 [8-27] versus 11 [4-37]). Because ODI did not increase in patients with OSAS and PNP who received postoperative oxygen overnight, postoperative intensive care monitoring might not be necessary on a routine basis for all patients with PNP and OSAS.

Anesthetic management of juvenile nasopharyngeal angiofibroma resection.

OBJECTIVE: To evaluate the anesthetic implications of the surgical resection of juvenile nasopharyngeal angiofibroma (JNA). DESIGN: Retrospective study. SETTING: University-affiliated community hospital. PARTICIPANTS: Ten patients undergoing resection of JNA. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data from the records of 10 patients undergoing resection of JNA were reviewed and analyzed with regard to demographics, history of the disease, characteristics of the tumor, surgical resection techniques, and anesthetic management. Patients were age 11 to 29 years. All had nasal obstruction as presenting symptom. There was no intracranial invasion. Eight tumors were resected via a lateral rhinotomy and 2 endoscopically (after embolization of the tumor's feeding vessels). Duration of surgery was 6 +/- 1 hours for rhinotomy and 6 and 6.5 hours for the 2 endoscopic resections. Anesthesia was induced in a rapid-sequence manner. Arterial and central venous catheters were placed in all patients. Mean arterial pressure was targeted to 55 to 65 mmHg by using increasing concentrations of isoflurane. The estimated blood loss was 4,800 +/- 1,600 mL and blood replacement was 3,200 +/- 1,400 mL in the first group. The 2 other patients lost 600 mL and 1,500 mL. Blood replacement in this group was 0 and 700 mL respectively. No mortality or major morbidity occurred. CONCLUSION: Resection of JNA should be considered a major procedure with many anesthetic challenges. Isoflurane may be employed to provide deliberate hypotension.

Nocturnal oxymetry in patients with total nasal packing.

Nocturnal oxymetry was recorded in ten otherwise healthy patients undergoing different types of nasal surgery with total nasal packing. Postoperative nocturnal oxymetry was worse than preoperative one in seven patients and judged as abnormal in four. These results indicate that in otherwise healthy subjects, nasal surgery and total nasal packing induce immediate significant changes in nocturnal breathing.

The influence of nasal obstruction and its relief on oxygen saturation during sleep and the early postoperative period.

Nasal obstruction causes abnormal breathing patterns during sleep which often result in hypoxaemia. We studied the effect of nasal obstruction on arterial oxygen saturation in 20 healthy patients undergoing elective surgery which required bilateral nasal packing. Ten patients were subject to complete nasal obstruction while the remaining half had the obstruction relieved by the insertion of nasal cannulae. We found that nasal obstruction did not have any detrimental effect on the already low incidence of oxygen desaturation. There was no effect of the cannulae on the degree or frequency of hypoxaemia, although they did appear to improve the quality of sleep during the first postoperative night. They were more comfortable by day than simple packing alone and no adverse effects were observed.