Objectives: To compare total nasal resistance (TNR) in upright and supine positions in patients who did and did not complain of nocturnal (supine) nasal congestion symptoms without daytime (upright) ...congestion, and to determine what other conditions were associated with nocturnal nasal congestion (NNC) symptoms.
Study Design: A prospective study comparing objectively measured nasal airflow in different positions (upright and reclining) with subjective patient symptoms.
Methods: Subjects completed a questionnaire about nasal symptoms. Anterior rhinomanometry was performed with patients upright, reclined 45°, and supine. TNR in subject subsets was compared using the Student t test.
Results: TNR did not differ between upright patients with (n = 27) and without (n = 20) NNC. Supine TNR (P < .04) and increase in TNR (P < .02) between upright and supine was greater in patients with NNC. Smokers (n = 15, 10 with NNC, 5 without) had greater TNR increases when supine versus nonsmokers (P < .02). Patients with rhinitis symptoms (n = 29, 18 with NNC, 11 without) had greater TNR increases when supine than patients without rhinitis (P < .01). Patients who both smoked and had rhinitis (n = 11, 7 with NNC, 4 without) had a greater supine TNR than patients who smoked or had rhinitis alone (P < .02).
Conclusions: Some patients without daytime nasal congestion experience NNC. They have a significantly greater TNR increase when supine versus patients without NNC. Smokers and patients with rhinitis, with or without NNC, have a significantly greater TNR increase when supine versus nonsmokers or patients without rhinitis. Smoking cessation and treatment of rhinitis may improve the patients' NNC.
Background. A case of basal cell carcinoma (BCC) developing in the repair scar of a cleft lip is presented.
Objective. Primary BCCs arising in surgical scars are very rare and no known reported cases ...exist of a BCC developing in a surgically repaired cleft lip scar.
Methods. A 69‐year‐old white man presented with a 5 mm primary BCC on his upper lip at the site of his cleft lip repair scar. The diagnosis was made by a tangential biopsy that showed an ulcerated BCC.
Results. Review of the medical literature indicates that a scar may be an independent risk factor for developing BCC.
Conclusion. BCC may rarely arise in a cleft lip repair scar.
Lipoproteins isolated from normal human plasma can bind and neutralize bacterial lipopolysaccharide (LPS) and may represent an important mechanism in host defense against gram-negative septic shock. ...Recent studies have shown that experimentally elevating the levels of circulating high-density lipoproteins (HDL) provides protection against death in animal models of endotoxic shock. We sought to define the components of HDL that are required for neutralization of LPS. To accomplish this we have studied the functional neutralization of LPS by native and reconstituted HDL using a rapid assay that measures the CD14-dependent activation of leukocyte integrins on human neutrophils. We report here that reconstituted HDL particles (R-HDL), prepared from purified apolipoprotein A-I (apoA-I) combined with phospholipid and free cholesterol, are not sufficient to neutralize the biologic activity of LPS. However, addition of recombinant LPS binding protein (LBP), a protein known to transfer LPS to CD14 and enhance responses of cells to LPS, enabled prompt binding and neutralization of LPS by R-HDL. Thus, LBP appears capable of transferring LPS not only to CD14 but also to lipoprotein particles. In contrast with R-HDL, apoA-I containing lipoproteins (LpA-I) isolated from plasma by selected affinity immunosorption (SAIS) on an anti-apoA-I column, neutralized LPS without addition of exogenous LBP. Several lines of evidence demonstrated that LBP is a constituent of LpA-I in plasma. Passage of plasma over an anti-apoA-I column removed more than 99% of the LBP detectable by ELISA, whereas 31% of the LBP was recovered by elution of the column. Similarly, the ability of plasma to enable activation of neutrophils by LPS (LBP/Septin activity) was depleted and recovered by the same process. Furthermore, an immobilized anti-LBP monoclonal antibody coprecipitated apoA-I. The results described here suggest that in addition to its ability to transfer LPS to CD14, LBP may also transfer LPS to lipoproteins. Since LBP appears to be physically associated with lipoproteins in plasma, it is positioned to play an important role in the neutralization of LPS.
Abstract Background Shoulder pain and surgery are common among older adults. However, the extent to which older age affects recovery after shoulder surgery is not well understood. Objective To assess ...influence of older age on postoperative recovery factors 3 and 6 months after shoulder arthroscopy. Design Prospective cohort study. Setting University-affiliated outpatient orthopedic surgical center. Patients A convenience sample of 139 persons between 20 and 79 years of age who experienced shoulder pain, had musculoskeletal dysfunction based on imaging and physician assessment, and were scheduled for an arthroscopic shoulder procedure. Main Outcome Measures Postoperative outcomes were compared among younger, middle-aged, and older adults before surgery and at 3 and 6 months after surgery using analysis of variance modeling. Movement-evoked pain and an experimental laboratory correlate of pain processing were assessed at each time point. The influence of older age on 3- and 6-month pain outcomes were determined via multivariate regression analyses after accounting for preoperative, intraoperative, and postoperative prognostic factors. Results Older adults had higher movement-evoked pain intensity (F2,108 = 5.18, P = .007) and experimental pain response (F2,111 = 7.24, P = .001) at 3 months compared with young and middle-aged adults. After controlling for key prognostic factors, older age remained a positive predictor of 3-month movement-evoked pain ( R 2 = 0.05; standardized St. β = 0.263, P = .031) and experimental pain response ( R 2 = 0.07; St. β = 0.295, P = .014). Further, older age remained a positive predictor of movement-evoked pain at 6 months ( R 2 = 0.04; St. β = 0.231, P = .004), despite no age group differences in outcome. Older age was found to be the strongest predictor of 3- and 6-month movement-evoked pain. Conclusion Older adults may experience more pain related to movement, as well as endogenous pain excitation, in the first few months after shoulder arthroscopy. Future age-related research should consider use of movement-evoked pain intensity and experimental pain response as pain outcomes, as well as the utility of such measures in clinical care.
To determine fungal allergen reactivity prevalence by intradermal dilutional testing in patients with and without chronic rhinitis or rhinosinusitis symptoms.
Prospective comparison of fungal ...allergen reactivity prevalence in symptomatic and asymptomatic patients.
University medical center.
Group I (chronic rhinitis and/or rhinosinusitis symptoms) and Group II (asymptomatic) patients underwent intradermal dilutional testing with usual and fungal allergens.
Fungal reactivity occurred in 65% (13/20) of Group I, and 13% (4/30) of Group II (P < 0.0002 by chi(2) testing). Group I was more reactive to non-fungal allergens (85% vs. 33%, p < 0.0004), and to all allergens considered together (95% vs. 40%, p < 0.0001).
Patients with chronic rhinitis and rhinosinusitis symptoms were more reactive to fungal and nonfungal allergens. Fungal allergens were as likely as nonfungal to elicit reactivity.
These findings suggest a role for fungal hypersensitivity in chronic rhinitis and chronic rhinosinusitis.
Early thrombosis has complicated human stent implantation in several trials. To determine the best anticoagulation/antiplatelet therapy to maintain stent patency after percutaneous transluminal ...coronary angioplasty, we implanted the flexible balloon-expandable coil stent into the left anterior descending coronary artery of 28 atherosclerotic 8-month-old Hanford miniature swine. Animals were randomly assigned to one of three treatment groups: group A, aspirin (1 mg/kg/day) and dipyridamole (1 mg/kg three times a day); group B, aspirin and dipyridamole (same doses) plus Coumadin (dose required to prolong prothrombin time 1.3-1.5-fold that of normal); and group C, control. Adjuvant therapy was begun 3 days before stenting. Two pigs (one from group A and one from group B) died during implantation, both without thrombosis. Twenty-six animals survived until follow-up angiography and sacrifice at 1 month. No occlusive thrombosis of the stent occurred in survivors. Reduction of the stent lumen diameter was observed in every case at follow-up. Percent lumen reduction was 19% in group A, 26% in group B, and 24% in group C. Marked smooth muscle cell hyperplasia was seen by light and transmission electron microscopy at stent struts. Scanning electron microscopy of the luminal surface showed a variable morphology consisting of normal endothelium, adherent leukocytes, stellate periluminal cells, and occasional fibrin strands and red blood cells. Luminal narrowing was not affected by anticoagulation therapy, antiplatelet drugs, cholesterol level, or stent sizing. We conclude that occlusive thrombosis does not complicate stent implantation in this model but that substantial luminal narrowing due in part to smooth muscle hyperplasia does occur. The significance of luminal narrowing at the stent site requires further study.
Tracheal cartilaginous sleeve is characterized by the fusion of tracheal rings. Patients with tracheal cartilaginous sleeve may develop frequent respiratory tract infections, coughs, increased mucus ...production, sporadic cyanosis episodes, and failure to thrive due to alterations in the lower airway. Tracheal cartilaginous sleeve is seen exclusively in craniosynostosis. Craniosynostosis is described as the early fusion of skull sutures and causes abnormal development of the head. Crouzon syndrome is the most common syndromic craniosynostosis. Otolaryngologists may be asked to evaluate and manage breathing difficulties, sleep apnea, and hearing difficulties associated with Crouzon syndrome. Upper airway abnormalities such as hypertrophy of the tonsils and adenoids, midnasal stenosis, and choanal atresia have been reported. Lower airway abnormalities in the presence of obstructive airway symptoms have not been widely studied in Crouzon syndrome. We describe the diagnosis and management of multilevel airway problems in a child with Crouzon syndrome who presented with obstructive sleep apnea.
The Zen Canon Heine, Steven; Wright, Dale S
05/2004
eBook
The Zen Canon offers learned but accessible studies of some of the most important classical texts in the tradition of Zen Buddhism. Each essay in the volume provides historical, literary, and ...philosophical commentary on a particular Zen text or genre of texts. Among the most prominent types of texts featured are Chan or Zen “recorded sayings” (yulu) texts, “transmission of the lamp” anthology texts (chuandenglu), koan collections, and “rules of purity” or monastic regulation texts. These canonical writings helped shape the overall conception of Zen Buddhism and the kinds of practices that have come to give Zen its identity. One theme of Zen Canon, therefore, is that the classical anti-textual posture of Zen Buddhism is not one that can be taken literally. While making fun of spiritual writing of all kinds, Zen Buddhists managed to produce one of the largest and most influential bodies of canonical texts in the world. Among the most famous Zen texts discussed in The Zen Canon are the Mazu yulu, the Lidai fabao ji, the Transmission of the Lamp Ching-te era, the Record of Hongzhi, the Wu-men kuan, and the Chanyuan qinggue.
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