PURPOSE: To evaluate the incidence and the site of osteomas and their relation to sinonasal inflammation. MATERIALS AND METHODS: 1578 PNS computed tomography (CT) of patients with symptoms of sinusitis were evaluated and correlation with plain radiographic finding was done. RESULTS: The total incidence of osteomas was 0.82%(13/1578) on plain radiography and 3.29% (52/1578) on CT. Fifty-seven osteomas were found in 1578 PNS CT, including 2 osteomas in 5 cases. The most common site was the ethmoid sinus(54%, 31/57) and the next was the frontal sinus(35%, 20/57) on CT. Forty-five osteomas (78.9%) were associated with the sinonasal inflammatory change. CONCLUSION: The total incidence of osteomas from our results was higher than previous reports. And based on the analysis of CT, the most common site was not the frontal sinus as all the previous reports stated, but the ethmoid sinus, probably by virtue of high resolution of CT and/or higher prevalence of inflammation in the ethmold sinus.
Ethmoid Sinus ; Frontal Sinus ; Humans ; Incidence ; Inflammation ; Osteoma* ; Prevalence ; Radiography ; Sinusitis ; Virtues

BACKGROUND: It has been known that arterial carbon dioxide tension is 4~5 mmHg higher than end-tidal carbon dioxide tension in healthy adults during general anesthesia. But negative arterial to end-tidal PCO2 difference was reported in pregnant patients undergoing cesarean section. The purpose of this study was to elucidate the difference between arterial and end-tidal PCO2 in anesthetized patients with reduced functional residual capacity. METHODS: 90 patients were divided into 3 groups i.e. control group (n=30), obese group (n=20, body weight more than 20% greater than ideal weight), pregnant group (n=40). All patients had no cardiac or respiratory abnormalities and never smoked. Arterial blood gas analysis and measurement of end-tidal PCO2 were done 20 minutes after induction of anesthesia in control and obese group and just before uterine incision and 20 minutes after fetal delivery in pregnant group. RESULTS: There were significant correlations between arterial and end-tidal PCO2 in all groups. The incidences of negative arterial to end-tidal PCO2 difference were 10% in control group, 40% in obese group, 42.5% in pregnant group (p<0.05). CONCLUSION: From this study, it is concluded that patients with reduced functional residual capacity have more incidences of negativity than normal patients in the values of arterial to end-tidal PCO2 difference during general anesthesia. So when the tight control of PaCO2 is required in patients with reduced FRC, we recommend to measure PaCO2 for better anesthetic management.
Adult ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Body Weight ; Carbon Dioxide* ; Carbon* ; Cesarean Section ; Female ; Functional Residual Capacity* ; Humans ; Incidence ; Pregnancy ; Smoke

PURPOSE: To evaluate the incidence and CT findings of the medial depression and bony dehiscence of lamina papyracea as an anatomic variation. MATERIAL AND METHODS: 1472 PNS CTs of the patients with symptoms of chronic sinusitis were retrospectively evaluated. RESULTS: The total incidence of depressed lamina papyracea as an anatomic variation was 3.5%(52/1472) on PNS CT. There was a statistically significant correlation between the increasing age and the incidence of delamina papyracea. Depression of lamina papyracea anterior to the basal lamella were more common those of the posterior depression. Associated findings were herniation of adjacent fatty tissue in all cases and the roedial bowing and hypertrophied configuration of the medial rectus muscle without significant herniation in 19 cases(34%). CONCLUSION: Nontraumatic, asymptomatic depression with bony dehiscence of lamina papyracea as an anatomic variation is not uncommon with the incidence of 3.5%. Recognition of its existence and degree may helpful in avoiding various ocular complication during ethmoid surgery.
Adipose Tissue ; Anatomic Variation* ; Depression* ; Humans ; Incidence ; Retrospective Studies ; Sinusitis

No abstract available.
Rhinomanometry*

Sustained downgaze mostly occurs in association with lesions affecting the dorsal midbrain. We report sustained downgaze in a patient with hepatic encephalopathy. The sustained downgaze existed for seven more days after she regained her consciousness. The persistent downgaze even after regaining full consciousness indicates localized pretectal dysfunction rather than diffuse encephalopathy as the mechanism of sustained downgaze in our patient. The ocular motor dysfunction in hepatic encephalopathy may be due to localized dysfunction of the brainstem

Surgical reconstruction of the anterior cruciate ligament is undergoing constant evolution. The variable success of these procedures can be attributed to many factors including graft selection, graft placement, graft tensioning, graft remodelling and rehabilitation program. Rigid fixation is probably the most important factor in the success of these procedures during the initial stages of healing. Arthroscopically assisted reconstruction of the ACL-deficient knee using a bone-patellar tendon-bone graft(two-incision technique) is a reliable and evolving technique. Rosenberg et al, described a one-incision technique that allows endosteal fixation of bone plugs within their femoral tunnels intraarticularly via the intercondylar notch. These two techniques are different from their femoral tunnel direction and bone plug placement. The present study was designed to develop a swine model for in vitro biomechanical testing of the bone-patellar tendon-bone ACL autograft to compare the pull-out strength of Outside-In technique and Inside-Out technique. The result were as follows: 1. Normal ACL(N=10 knees) pull-out tensile strength tests showed a maximum tensile strength of 1295.34(N), a stiffness of 120.95(N/mm), and a linear load of 1104.26(N). The failure sites were all tibial attachments. 2. Femoral and Tibial interference fit pull-out tensile strength tests(N=10 knees) showed a maximum tensile strength of 463.23±42.27(N), a stiffness of 33.62±3.18(N/mm), and a linear load of 392.51±95.42(N). The failure sites were all in the tibial tunnel area(N=9 knees), except for one which femoral tunnel area. 3. Inside-Out technique(N=15 knees) showed a maximum tensile strength of 1250.64±75.67(N), a stiffness of 94.31±26.44(N/mm), and a linear load of 1046.92±367.55(N), but the Outside-In tech-nique(N=15 knees) showed a maximum tensile strength of 805.35±54.61(N), a stiffness of 83.33±10.98(N/mm), and a linear load of 685.99±86.32(N)(p < 0.0001). The failure sites were all in the femoral tunnel area. 4. Tensile testing demonstrated that the Inside-Out technique was significantlly stronger than Outside-In technique for maximum tensile strength, stiffness and a linear load.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Autografts ; In Vitro Techniques ; Knee ; Rehabilitation ; Swine ; Tensile Strength ; Transplants

Vertigo and dizziness are amongst the most frequent presenting symptoms in the emergency room, accounting for up to 4% of all emergency consultations. The broadness of their differential diagnosis and the often transient nature of these symptoms pose a significant challenge to the treating physician. Combining various subtle oculomotor signs at the bedside has been very successful in distinguishing peripheral from central causes in acutely dizzy patients meeting diagnostic criteria for the acute vestibular syndrome (i.e., acute and prolonged vertigo or dizziness accompanied by nausea or vomiting, gait imbalance, motion intolerance, and [not mandatory] nystagmus). While the diagnostic accuracy of the HINTS (Head-Impulse—Nystagmus—Test-of-Skew) algorithm has been studied extensively, less is known about the value of various nystagmus patterns seen at the bedside in patients with an acute vestibular syndrome.Here we review both spontaneous and triggered presenting nystagmus patterns and discuss their impacts and limitations, including primary-gaze horizontal, vertical, and torsional nystagmus, nystagmus during eccentric gaze, and nystagmus triggered by stimuli such as headshaking, hyperventilation, positional testing, vibration, and the Valsalva maneuver. We conclude that the usefulness of nystagmus patterns in discriminating peripheral and central causes strongly depends on the pattern seen and the type of testing performed, being highly predictive of a central cause for torsional and vertical spontaneous nystagmus, downbeat, or apogeotropic horizontal and treatment-refractory positional nystagmus. The predictive value for central causes was moderate only for vertical nystagmus after horizontal head-shaking (“perverted” head-shaking nystagmus) since it can also occur in peripheral cases, while the predictive value was low for vibration-induced nystagmus and Valsalva-induced nystagmus.

Vertigo and dizziness are amongst the most frequent presenting symptoms in the emergency room, accounting for up to 4% of all emergency consultations. The broadness of their differential diagnosis and the often transient nature of these symptoms pose a significant challenge to the treating physician. Combining various subtle oculomotor signs at the bedside has been very successful in distinguishing peripheral from central causes in acutely dizzy patients meeting diagnostic criteria for the acute vestibular syndrome (i.e., acute and prolonged vertigo or dizziness accompanied by nausea or vomiting, gait imbalance, motion intolerance, and [not mandatory] nystagmus). While the diagnostic accuracy of the HINTS (Head-Impulse—Nystagmus—Test-of-Skew) algorithm has been studied extensively, less is known about the value of various nystagmus patterns seen at the bedside in patients with an acute vestibular syndrome.Here we review both spontaneous and triggered presenting nystagmus patterns and discuss their impacts and limitations, including primary-gaze horizontal, vertical, and torsional nystagmus, nystagmus during eccentric gaze, and nystagmus triggered by stimuli such as headshaking, hyperventilation, positional testing, vibration, and the Valsalva maneuver. We conclude that the usefulness of nystagmus patterns in discriminating peripheral and central causes strongly depends on the pattern seen and the type of testing performed, being highly predictive of a central cause for torsional and vertical spontaneous nystagmus, downbeat, or apogeotropic horizontal and treatment-refractory positional nystagmus. The predictive value for central causes was moderate only for vertical nystagmus after horizontal head-shaking (“perverted” head-shaking nystagmus) since it can also occur in peripheral cases, while the predictive value was low for vibration-induced nystagmus and Valsalva-induced nystagmus.