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Fiber type composition of the muscle responsible for throat fan extension in green anole lizards.

Throat fan (dewlap) extension is sexually dimorphic in green anole lizards (Anolis carolinensis). Males have larger dewlaps which they display more frequently than females. Correlated with the behavior, sexual dimorphisms occur in the skeletal, muscular and neural structures responsible for dewlap extension in green anoles. We used histochemical techniques to stain for myosin ATPase and succinate dehydrogenase (SDH) to determine whether sex differences also exist in fiber type composition of the ceratohyoideus, the muscle that extends the dewlap. Based on the staining pattern for the two enzymes, four fiber types were identified: fast-oxidative-glycolytic (FOG), fast-glycolytic (FG), slow-oxidative (SO), and tonic. In the ceratohyoideus of both sexes, the predominate fiber types were FOG (approximately 43%) and FG (approximately 34%). Also in both males and females, the FOG and FG fibers had approximately twice the cross-sectional area of the SO and tonic fibers. No sex differences occurred in the percentages of FOG and FG fibers. However, males had a greater percentage of tonic fibers than females, whereas females had a greater percentage of SO fibers than males. The high proportion of FOG fibers in the anole ceratohyoideus makes it similar to other relatively fatigue-resistant muscles used in movements of moderate speed and duration. Although the precise role of tonic fibers in dewlap extension is not known, the greater percentage of these fibers in the male ceratohyoideus might be required to stabilize or maintain extension of the large dewlap apparatus in males.

Animals↗

Management of sore throat by family physicians in northeastern Poland: possible benefits of applying clinical algorithm.

BACKGROUND: The objective of this study was to describe current sore throat management practices among family physicians and to estimate potential benefits of applying clinical algorithm - Centor's scale (presence of tonsillar exudates, fever, lymphadenopathy and absence of cough) in decision-making process. METHODS: Each of 44 participating family physicians was asked to fill in questionnaires for 30 consecutive patients with respiratory tract infection. RESULTS: Almost all decisions were made on clinical grounds. Among 169 adult patients with the clinical diagnosis of bacterial pharyngitis only 55% fulfilled 3 or more criteria on Centor's scale. CONCLUSIONS: Family physicians overdiagnose bacterial pharyngitis. Screening adult patients with Centor's criteria would probably lead to a reduction in the prescribing of antibiotics.

Adult↗

Clinical and laboratory evaluation of the effect of cephradine on patients with ear, nose and throat infections.

27 patients with ear, nose and throat infections have been treated with cephradine orally. Ten patients received 250 mg and 17 patients 500 mg every 6 h during 10 days. 26 patients were cured. One patient failed to respond to treatment but reinfection could not be excluded. Determination of plasma concentrations showed that cephradine was well absorbed. The drug showed no severe adverse effects. Cephradine is a good replacement in patients with allergy to penicillins. It is also suitable when broad-spectrum therapy is needed.

Administration, Oral↗

Generalized drug reaction due to papaya juice in throat lozenges.

We report the case of a 55-year-old woman without a history of atopic disease or drug allergy who developed a maculopapular symmetric exanthematous rash about 2 days after taking throat lozenges containing papaya juice. Patch tests gave negative reactions to the European standard series but were positive for papaya juice. A solution of 1% papain in water showed a weak and probably irritant reaction, while a 0.1% solution was negative. To our knowledge this is the first case report of systemic contact dermatitis to papaya without papain hypersensitivity.

Drug Eruptions↗

Nasal provocation with bradykinin induces symptoms of rhinitis and a sore throat.

Kinins are generated in nasal secretions during allergic reactions and during induced rhinovirus colds. To determine if kinins may contribute to the symptomatology of these inflammatory reactions, 8 subjects were challenged with increasing doses of bradykinin or with placebo. Levels of albumin, histamine, and N-alpha-tosyl-L-arginine methyl ester (TAME)-esterase were measured in nasal lavages, and symptom scores were noted. No symptoms or increases in mediators or protein were observed after placebo challenge. Symptom scores increased in a dose-dependent manner, however, in response to bradykinin challenge. Increased symptoms were associated with significant increases in albumin and TAME-esterase activity, but no increases in histamine were observed. Nasal conductance measurements confirmed that bradykinin induces dose-dependent unilateral obstruction in the challenged nostril. Other common symptoms were rhinorrhea and, of particular relevance to rhinovirus infections, a persistent sore throat. We conclude that bradykinin causes increased vascular permeability and rhinitis, which are independent of mast cell mediator release. Kinins may, therefore, contribute to the symptomatology of inflammatory reactions of the upper airways, including the common cold.

Adult↗

Suicidal stab wounds of the throat.

Suicide by stabbing one's throat remains very rare and very few cases have been reported in the forensic literature. In such cases, the important distinction is between suicide and homicide. The direction of stab wounds, their depth, site and number have particular importance in helping to recognize suicide. Suicide when attempted by transfixion of the neck in middle aged and elderly adults often reveals a definite resolution to kill oneself.

Adult↗

Profile of cataract patients in the Eye, Ear, Nose and Throat Hospital, Rangoon.

We report on our experience of cataract surgery in the Eye, Ear, Nose and Throat Hospital (EENTH), Rangoon. Cataract patients constituted 52% of all those admitted with eye diseases to the EENTH in a year. The mean number of cataract cases operated per month was 282. Among cataracts the senile form was the commonest. The female to male ratio for senile cataract patients was 1.2, and the average age at admission was 68 years. The mean duration of stay in hospital was 7 days with an operation time of 19 min. The patients had to come to hospital for follow-up for an average period of 3.1 months to complete treatment. The need to consider cataract surgery as an outpatient procedure is discussed.

Adolescent↗

Feeling of a lump in the throat: thoughts of a radiologist.

Radiological examination of over 300 patients complaining of feeling a lump in the throat and difficulty in swallowing, but in whom there was no visible lump, showed that in most cases there was no significant abnormality above the thoracic inlet. Oesophageal examination revealed no abnormality in one-third; definite gastric reflux with or without hiatus hernia in one-third; and impaired clearance of fluid in the horizontal position in the remainder. Reflux and impaired clearance were either seen spontaneously or were induced after the ingestion of hydrochloric acid of the same pH as gastric juice.

Conversion Disorder↗

The Ear, Nose, and Throat Devices Classification Panel of the Food And Drug Administration.

The passage into law in 1976 of the Medical Device Amendments authorized the FDA to regulate the safety and efficacy of medical devices. The effects of this regulation are contrasted with the mode of entry of medical devices onto the market prior to 1976. The structure and operation of Ear, Nose, and Throat Devices Classification Panel is described briefly. Continued input from otolaryngologists and allied professionals is encouraged.

Legislation, Medical↗

The diagnosis of strep throat in adults in the emergency room.

Adult patients who presented to an urban emergency room complaining of a sore throat had cultures and clinical information recorded. Models were constructed, using logistic regression analysis, of both a positive culture for Group A beta streptococcus and a positive guess by a resident. The model of a positive culture consisted of four variables--tonsillar exudates, swollen tender anterior cervical nodes, lack of a cough, and history of fever. Patients with all 4 variables had a 56% probability of a positive culture; 3 variables, 32%; 2 variables, 15%; 1 variable, 6.5%; and 0 variables, 2.5%. The model of a positive guess by a resident demonstrated an over-reliance on physical exam and an underuse of history. The model of a positive culture allows stratification of patients to assist clinicians in the management strategies.

Adolescent↗

Nimesulide for the treatment of painful inflammatory process in the ear, nose and throat areas: a double-blind controlled study with benzydamine.

Nimesulide, 4-nitro-2-phenoxymethanesulphonanilide, a new non-steroidal anti-inflammatory drug endowed with potent anti-inflammatory, analgesic and antipyretic activities, was tested at a daily dose of 200 mg b.i.d. against Benzydamine on a double-blind basis, in a randomized trial with fifty out-patients suffering from inflammatory ear, nose and throat diseases (otitis media, sinusitis, rhinitis). Nimesulide treatment brought about an immediate and significant improvement in over-all pain, exudation, oedema and headache and produced a rapid lowering in body temperature. The recovery was more rapid and significant in patients with Nimesulide than in those with Benzydamine. The signs and symptoms under consideration reached almost complete resolution within the set treatment-period of 10 days. Clinical tolerability of Nimesulide was better than that of Benzydamine: one case of moderate gastric pyrosis and drowsiness was complained of by the Nimesulide-treated patients versus eleven cases of gastro-intestinal discomfort, mouth dryness, and/or drowsiness which were complained of by the Benzydamine-treated patients.

Adult↗

Managing the Fife ENT (ear, nose and throat) waiting list: the 1989 review of problems.

In-patient activity of Fife Ear, Nose and Throat (ENT) wards and of Fife ENT consultants are higher than the Scottish averages. Out-patient activity appears to operate at a lower level and hundreds of patients remain on the Fife waiting list for operations. An analysis of 731 patients on the ENT waiting list in 1989 showed that 15% had been waiting for over three years. Over 350 hours of theatre time and over 3,200 in-patient bed days would be required to clear this waiting list. Adopting a guillotine tonsillectomy operative procedure without anaesthesia would make a major contribution to a rapid reduction of the waiting list. Although this is reported to be quick, relatively painless and remarkably free from haemorrhagic complications, it appears not to be acceptable in our medical culture at the moment. A life table analysis suggests that Fife is failing to operate on patients at a rate compatible with the needs of the community: current trends of operating suggest that over one half of patients will be on the waiting list for operations three years after being placed on it. The Secretary of State's 1989-90 waiting list initiative, the appointment of an extra ENT consultant and the allocation of additional operating theatre time may help to resolve these difficulties.

Bed Occupancy↗

A throat lozenge containing amyl meta cresol and dichlorobenzyl alcohol has a direct virucidal effect on respiratory syncytial virus, influenza A and SARS-CoV.

A potent virucidal mixture containing amyl metacresol and dichlorobenzyl alcohol at low pH inactivated enveloped respiratory viruses influenza A, respiratory synctial virus (RSV) and severe acute respiratory syndrome coronavirus (SARS-CoV) but not viruses with icosahedral symmetry, such as adenoviruses or rhinoviruses. A titre of approximately 3.5 log10 TCID50 was reduced to below the level of detection within two minutes. Electron microscopy of purified influenza A virus showed extensive clumping and morphological changes in spike configuration after contact with the virucidal mixture, but no overt destruction of the viral membrane. We conclude that, formulated as a lozenge, the mixture could have significant effects in reducing the infectivity of certain infectious viruses in the throat and presumably in cough droplets, thus reducing, theoretically, opportunities for person-to-person transmission.

Adenoviridae↗

Choking, sore throat with referred otalgia and dysphagia in a patient with diffuse idiopathic skeletal hyperostosis (DISH).

A patient with a progressively increasing immobilisation of the cervical spine, severe impaired swallowing (choking), sore throat with referred right-sided otalgia, mild voice disorder and dysphagia due to extrinsic bone compression of the posterior hypopharyngeal wall and oesophagus is presented. Radiographic investigation demonstrated the underlying condition to be a diffuse idiopathic skeletal hyperostosis with prominent and bumpy alteration of the anterior longitudinal ligament impinging the hypopharynx. Via an anterolateral approach towards the cervical spine the anterior irregular part of the ossification was removed and the surface of the spine flattened. The postoperative evolution was uneventful.

Aged↗

Traditional management of ear, nose and throat (ENT) diseases in Central Kenya.

Diseases of ear, nose and throat (ENT) often have serious consequences including hearing impairment, and emotional strain that lower the quality of life of patients. In Kenya, upper respiratory infections are among the most common infections encountered in outpatient facilities. Some of these infections are becoming difficult to control because some of the causing microorganisms have acquired antibiotic resistance and hence the need to develop new drugs with higher efficacy. Ethnobotanical studies have now been found to be instrumental in improving chances of discovering plants with antimicrobial activity in new drug development. In Kenya the majority of local people are turning to herbal remedies for primary health care needs. In most cases the sources of these remedies are undocumented and the knowledge about them passed orally form generation to generation, hence under threat of disappearing with current rates of modernisation. This study explored the traditional remedies used in managing various ENT diseases in seven districts of the Central Province of Kenya. The most common ENT conditions managed using traditional therapies include: common cold, cough, tonsillitis, otitis-media, chest pains and asthma. The results indicate that 67 species belonging to 36 plant families were utilized in this region. These plants were of varying habits; herbs (37.3%), shrubs (34.4%), trees (25.4%) as well as some grasses and sedges (3%). The traditional preparations were found to be made mainly from leaves (49%), roots (20.5%) and barks (12.5%). For each of the ENT conditions multiple species are utilized mainly as individual preparations but occasionally as polyherbal concoctions. In the case of common cold for example, 30 different species are used. Plants reported in this survey are important candidates for antimicrobial tests against ENT disease causing micro-organisms, especially those with antibiotic resistance.

Asthma↗

Palifermin reduces patient-reported mouth and throat soreness and improves patient functioning in the hematopoietic stem-cell transplantation setting.

PURPOSE: To describe patient-reported outcomes of mouth and throat soreness (MTS) and related sequelae on daily activities from a phase III study of palifermin in the autologous hematopoietic stem-cell transplantation (HSCT) setting and to compare patient self-evaluations with clinicians' assessments of oral mucositis using objective scales. PATIENTS AND METHODS: Patients (n = 212) received palifermin (60 microg/kg/d) or placebo for 3 days before total-body irradiation (12 Gy), etoposide 60 mg/kg, and cyclophosphamide 100 mg/kg, and 3 days after HSCT. Patients completed a daily questionnaire (Oral Mucositis Daily Questionnaire [OMDQ]) evaluating MTS severity and its effects on daily functional activities. Patients' self-assessment data were compared with clinicians' assessments of oral mucositis using the objective scales. RESULTS: Palifermin reduced the incidence and duration of severe oral mucositis, as assessed by both clinicians and patients. Comparisons between patient and clinician assessments demonstrated that the average daily scores between mucositis grade and subjective (MTS) instruments were similar, although patients reported MTS onset, peak, and resolution earlier (1 to 3 days) than clinicians' assessments. Patients receiving palifermin reported statistically significant improvements (P < .001) in daily functioning activities (swallowing, drinking, eating, talking, sleeping) and required significantly less narcotic opioids (P < .001); improvement in the patient's overall physical and functional well-being was also reported. This was confirmed by the results of the Functional Assessment of Cancer Treatment questionnaire. CONCLUSION: These results support the clinical benefit of palifermin in the HSCT setting, providing evidence that a patient's self-assessment instrument (OMDQ) may serve as an alternative tool to assess oral mucositis severity in clinical trials.

Adult↗

Gargling with sodium azulene sulfonate reduces the postoperative sore throat after intubation of the trachea.

Postoperative sore throat (POST) is a complication that remains to be resolved in patients undergoing endotracheal intubation. In this study, we investigated whether preoperative gargling with sodium 1,4-dimethyl-7-isopropylazulene-3-sulfonate monohydrate (sodium azulene sulfonate, Azunol) reduces POST after endotracheal intubation. Forty patients scheduled for elective surgery under general anesthesia were randomized into Azunol and control groups. In the Azunol group, patients gargled with 4 mg Azunol diluted with 100 mL tap water (40 microg/mL). In the control group, patients gargled with 100 mL of tap water. After emergence from general anesthesia, the patients with POST were counted and POST was evaluated using a verbal analog pain scale. There were no significant differences between the two groups by age, height, body weight, gender distribution, or duration of anesthesia and surgery. In the control group, 13 patients (65%) complained of POST, which remained 24 h later in nine patients (45%). In the Azunol group, five patients (25%) also complained of POST, which completely disappeared by 24 h later. The incidence of POST and verbal analog pain scale scores in the Azunol group decreased significantly compared with the control group. We demonstrated that gargling with Azunol effectively attenuated POST with no adverse reactions.

Administration, Oral↗

Desflurane anesthesia after sevoflurane inhaled induction reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance.

Emergence agitation may occur after general anesthesia with volatile anesthetics in children. We designed this study to examine the emergence behavior of children undergoing ear-nose-throat surgery after sevoflurane induction and desflurane maintenance versus both sevoflurane induction and maintenance using a recently published Pediatric Anesthesia Emergence Delirium (PAED) scale. In 38 premedicated children aged 12 mo to 7 yr mask induction with sevoflurane was performed and they were randomly assigned to receive either sevoflurane (n = 19) or desflurane (n = 19) for maintenance of general anesthesia. Time to tracheal extubation, modified Aldrete score, emergence behavior, recovery complications, and pain scores were assessed. The PAED scale showed a significant advantage for desflurane (6 [0-15] versus 12 [2-20], maximum total score of 20 for severe agitation). Time to extubation was significantly shorter with desflurane than with sevoflurane (5.4 +/- 1.4 versus 13.4 +/- 1.8 min). The modified Aldrete score on arrival in the postanesthesia care unit (PACU) was significantly lower in children receiving sevoflurane for maintenance. Time to discharge from PACU to normal ward and the incidence of adverse effects were not significantly different between the groups. In conclusion, the use of desflurane for maintenance of anesthesia after sevoflurane induction in children is associated with less severe emergence agitation and faster emergence times.

Anesthesia Recovery Period↗