Mild aortic stenosis and coronary bypass surgery

The presence of mild to moderate aortic stenosis in a patients scheduled for coronary bypass surgery poses difficult problems with respect to the optimal therapeutic strategy. The first step is obviously to obtain a precise quantification of the degree of stenosis. Whenever possible, confrontation with previous echo examinations will provide an idea of the speed with which aortic stenosis progresses. The cardiologist, together with the cardiac surgeon, will have to carefully balance the operative risk and the risk of a second intervention. The patient's age will be central in the discussion, as it is a major determinant of life expectancy after the initial intervention.     

Nasal airflow and resistance measured by active anterior rhinomanometry in healthy children and adolescents

Rhinomanometry allows objective assessment of nasal patency in pediatric patients with nasal and other respiratory problems. However, no reliable reference values are available in the pediatric age group. We measured nasal inspiratory airflow and nasal inspiratory resistance of the right and left nostrils (V'nar, V'nal, Rnar, and Rnal) and total nasal inspiratory flow and resistance (V'na and Rna) at a transnasal pressure of 150 Pa during quiet breathing in healthy children with a closed mouth by using active anterior rhinomanometry. Cross-sectional measurements were done in 192 healthy Caucasian children and adolescents free of nasal or other respiratory diseases (age, 2-19 years; body height, 94-190 cm; 95 boys and 97 girls). The values of V'na, V'nar, and V'nal increased significantly with an increase of body height or age (P<0.0001). Rna, Rnar, and Rnal significantly decreased with an increase of body height and age (P<0.0001). No significant statistical differences were found between boys and girls (P=0.11) or between right and left nostrils (P=0.07). V'nar and Rnar comprised 50.1%, and V'nal and Rnal 49.9%, of total V'na and Rna, respectively. Best-fit regression equations relating rhinomanometric parameters and body height or age were power functions. We obtained reference regression equations with upper and lower limits, and prepared tables listing reference (normal) values of rhinomanometric parameters in healthy pediatric Caucasian patients, against which patients with nasal obstruction can be compared.     

A case-control study of obstructive sleep apnea-hypopnea syndrome in obese and nonobese chinese children

BACKGROUND: Obesity is a risk factor for obstructive sleep apnea-hypopnea syndrome (OSAHS) in adults. However, the prevalence of OSAHS in children is not clear, and the relationship between obesity and OSAHS remains controversial. METHODS: Obese children were recruited from the endocrinology, respiratory, and ear, nose, and throat clinics. Weight-matched, age-matched, and sex-matched children were recruited as control subjects. Standard questionnaires were administered, and a standardized physical examination was carried out. Lateral neck roentgenography, sleep polysomnography, full blood count, and arterial blood gas analysis were also performed. Children with body mass index z-scores of > 1.96 were considered to be obese. An adenoidal/nasopharygeal ratio of > 0.67 was considered to constitute adenotonsillar hypertrophy (ATH). OSAHS was defined as an apnea-hypopnea index (AHI) score of > 5 or obstructive apnea index (OAI) score of > 1. RESULTS: Ninety-nine obese children and 99 control subjects were recruited into the study. Obese patients had significantly higher AHI and OAI scores, and lower sleep efficiency and minimum arterial oxygen saturation (MinSao(2)) than control subjects. The prevalence of OSAHS was significantly higher in obese children with or without the ATH groups than their nonobese counterparts (odds ratio, 1.9 vs 108, respectively; 95% confidence interval, 1.21 to 4.7 vs 6.2 to 191, respectively). Obesity, tonsillar hypertrophy, and adenoid hypertrophy were independent risk factors for OSAHS (p < 0.001, p = 0.042, and p = 0.004, respectively). There was a positive correlation between the degree of obesity and AHI (r = 0.535; p < 0.001), and an inverse correlation between obesity and MinSao(2) (r = -0.507; p < 0.001). End-tidal CO(2), Paco(2), and bicarbonate levels were within the normal range. CONCLUSIONS: Obesity is a risk factor for OSAHS, and the degree of obesity is positively correlated with the severity of OSAHS.     

Muscles Involved in Naris Dilation and Nose Motion in Rat

In a number of mammals muscle dilator nasi (naris) has been described as a muscle that reduces nasal airflow resistance by dilating the nostrils. Here we show that in rats the tendon of this muscle inserts into the aponeurosis above the nasal cartilage. Electrical stimulation of this muscle raises the nose and deflects it laterally towards the side of stimulation, but does not change the size of the nares. In alert head‐restrained rats, electromyographic recordings of muscle dilator nasi reveal that it is active during nose motion rather than nares dilation. Together these results suggest an alternative role for the muscle dilator nasi in directing the nares for active odor sampling rather than dilating the nares. We suggest that dilation of the nares results from contraction of muscles of the maxillary division of muscle nasolabialis profundus. This muscle group attaches to the outer wall of the nasal cartilage and to the plate of the mystacial pad. Contraction of these muscles exerts a dual action: it pulls the lateral nasal cartilage outward, thus dilating the naris, and drags the plate of the mystacial pad rostrally to produce a slight retraction of the vibrissae. On the basis of these results, we propose that muscle dilator nasi of the rat should be re‐named muscle deflector nasi, and that the maxillary parts of muscle nasolabialis profundus should be referred to as muscle dilator nasi. Anat Rec, 298:546–553, 2015. © 2014 Wiley Periodicals, Inc.     

Novel FREM1 mutations expand the phenotypic spectrum associated with manitoba‐oculo‐tricho‐anal (MOTA) syndrome and bifid nose renal agenesis anorectal malformations (BNAR) syndrome

Loss of function mutations in FREM1 have been demonstrated in Manitoba‐oculo‐tricho‐anal (MOTA) syndrome and Bifid Nose Renal Agenesis and Anorectal malformations (BNAR) syndrome, but the wider phenotypic spectrum that is associated with FREM1 mutations remains to be defined. We screened three probands with phenotypic features of MOTA syndrome. In one severely affected infant who was diagnosed with MOTA syndrome because of bilateral eyelid colobomas, a bifid nasal tip, hydrometrocolpos and vaginal atresia, we found two nonsense mutations that likely result in complete loss of FREM1 function. This infant also had renal dysplasia, a finding more consistent with BNAR syndrome. Another male who was homozygous for a novel stop mutation had an extensive eyelid colobomas, corneopalpebral synechiae, and unilateral renal agenesis. A third male child diagnosed with MOTA syndrome because of corneopalpebral synechiae and eyelid colobomas had a homozygous splice site mutation in FREM1. These cases illustrate that disruption of the FREM1 gene can produce a spectrum of clinical manifestations encompassing the previously described MOTA and BNAR syndromes, and that features of both syndromes may be seen in the same individual. The phenotype of FREM1‐related disorders is thus more pleiotropic than for MOTA and BNAR syndrome alone and more closely resembles the widespread clinical involvement seen with Fraser syndrome. Moreover, our first case demonstrates that vaginal atresia may be a feature of FREM1‐related disorders. © 2013 Wiley Periodicals, Inc.     

《金匮要略》“纳药鼻中”之“药”考释

[目的] 探讨《金匮要略·痉湿暍病脉证并治第二》“纳药鼻中”之“药”所指的具体方药。[方法] 从历代注家注疏入手,对不同观点进行源流上的梳理。同时,通过文字学考证,对“药”字在古汉语中的含义展开探讨。[结果] 对于“纳药鼻中”之“药”,历代注家观点大致可归纳为三类,即随文注解、认为“药”为具有某些特性的药物、认为“药”为瓜蒂散或其类方,其中认为“纳瓜蒂于鼻中”的观点流传较广。通过文字学考证,“药”在楚方言中有指代“白芷”之意,“纳药鼻中”即是“纳白芷于鼻中”,白芷治疗鼻病也为历代医家所习用。[结论] “纳瓜蒂于鼻中”与“纳白芷于鼻中”两种观点都具有一定证据支持,但从文献学角度和仲景书体例而言,“纳药鼻中”原意应为“纳白芷于鼻中”。     

Nose like the foot of a pot

Saddle nose is defined as a depression of the nasal dorsum, regardless of its dimensions or the anatomical structures involved. The purpose of this historical note is to discuss the term “nose like the foot of a pot (nez en pied de marmite)” used to describe this deformity in France between the 17th and 19th centuries and to recall its link with syphilis in the light of the texts of the time.