NEED FOR FACIAL REANIMATION AFTER OPERATIONS FOR VESTIBULAR SCHWANNOMA: PATIENTS PERSPECTIVE

A total of 779 patients operated on for vestibular schwannoma mostly by the translabyrinthine approach in Denmark during the period 1976-2000 answered a questionnaire about various postoperative consequences. In this paper we describe the patients' facial function evaluated by professionals one year postoperatively and self-evaluated by each patient according to the House-Brackmann scale at the time of the questionnaire. The patients' self-evaluation was more pessimistic than that of the professionals with 26% reporting House-Brackmann grade IV-VI, compared with 20%. One hundred and seventeen (15%) of 779 patients considered their facial palsy to be a big problem and 125 patients (16%) were interested in surgical treatment for the sequelae of facial palsy. Seventy-eight (10%) had already had some kind of operation, usually the VII-XII coaptation. Thirty-three of 61 patients who had already been operated on for facial palsy were interested in further surgical treatment. One hundred and ninety-five patients (25%) had some kind of operation on the eye, mostly (88%) a tarsorrhaphy. Reanimation procedures such as a palpebral gold weight or a spring, apparently still have a small place in Denmark. In conclusion, there seem to be a considerable and unmet need for surgical reanimation of facial function in patients with facial palsy after operations for vestibular schwannoma in Denmark.     

A MODEL FOR ABSORPTION OF LOW-VOLATILE TOXICANTS BY THE AIRWAY MUCOSA

Inhaled chemical toxicants can damage the lungs during two phases: (1) the first-pass phase, in which toxicants are initially absorbed through the air/blood barrier, or (2) the circulation-transport phase, in which toxicants are transported back through the lungs with the circulating blood. While respiratory-tract dosimetry for inhaled toxicants is relatively easy to evaluate for the circulation-transport phase, it is more problematic for the first-pass phase and can involve higher local concentrations of toxicants. This article describes a respiratory-tract dosimetry model that simulates both the rate of absorption and the local concentration of low-volatile organic toxicants in the airway mucosa. The model simulates the non-steady-state diffusion of organic solutes from the air interface through the epithelium and into the capillary bed below. Cellular tissues are described as a heterogeneous, two-phase medium, with a minor lipid phase dispersed in a major aqueous phase. Results show that the lipid-phase/aqueous-phase partition coefficient, PC L/A', is a critical factor in determining the rate of absorption of solutes in the airway mucosa. For a PC L/A in the range 1 to 100, absorption is limited by blood flow and occurs with typical half-times from about 1 to 10 min. As PC L/A increases above 100, absorption is gradually limited by the rate of diffusion through the air/blood barrier, and absorption half-times increase to hours. Over the same range, the concentration gradient in the mucosa changes from almost uniform to more nonuniform, and the site-of-entry epithelium becomes more selectively exposed. As a result, with increasing PC L/A', protoxicants of lower reactivities can still be activated in significant quantities in the airway epithelium and thus act as site-ofentry toxicants. The presented results are important for understanding exposure/target-dose relationships of chemical carcinogens and for conducting reliable risk assessments.     

The relationship of the musculocutaneous nerve to the brachial plexus evaluated by MRI

Axillary plexus blocks (AXB) are widely used for upper limb operations. It is recommend that AXB should be performed using a multiple injection technique. Information about the course and position of the musculocutaneous nerve (MCN) is of relevance for AXB performance. The objective of this study was to examine the position of the MCN and its relationship to the axillary sheath using MRI. 54 patients underwent an AXB with 40 ml of local anaesthetic before MRI examination. The course of the MCN and the position where it left the axillary sheath and perforated the coracobrachial muscle (MCN exit point), in relation to the axillary artery and the block needle insertion point in the axillary fold, were recorded. The MCN was seen clearly in 23, partly in 26, and not identified in five patients at the MCN exit point. The mean distance from the insertion point of the block needle in the axillary fold to the MCN exit point was 36.8 mm (SD = 18.9, range: 0–90.5). In 37 patients the MCN exit point was positioned inside the Q₁ quadrant (lateral anterior to the axillary artery) and in 11 patients inside the Q₂ quadrant (medial anterior to the axillary artery). There is a wide variability as to where the musculocutaneous nerve (MCN) leaves the axillary sheath. Therefore multiple injection techniques, or the use of a proximally directed catheter, should be appropriate to block the MCN.     

Bone and joint tuberculosis in Denmark: Increase due to immigration

We studied the epidemiology of bone and joint tuberculosis (TB) in Denmark during the period 1993-1997, using data in the national Danish TB register. We found 95 cases, accounting for 4% of all tuberculosis cases and 15% of extrapulmonary cases, giving a mean annual incidence of 0.4 per 10 5 in the period. 26 cases were found among native Danes (3-8 cases per year) with a median age of 66 (10-92) years and giving a mean annual incidence of 0.1 per 10 5 . Among immigrants, an increasing number of cases of bone and joint TB were diagnosed, increasing from 5 in 1993 to 28 in 1997, giving a total of 69 cases with a mean age of 35 (11-75) years and a mean annual incidence of 4 per 10 5 in the period. The spine was affected in half of the cases. 28 patients had active TB elsewhere in the same period. In most patients, there were no predisposing or risk factors for disease except for ethnicity. Compared to a study of bone and joint TB in Denmark in the 1980s, the total incidence is the same, but there has been a shift in patients from old Danes to young immigrants. The increasing number of bone and joint TB cases among immigrants is due to recent immigration of Somalian refugees, who have a high incidence of TB and a high proportion of extrapulmonary TB. The diagnosis was often delayed several months or years. This study shows that attention must be paid to this condition, particularly in young patients from an endemic immigrant population.