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Purpose: Dacryocystorhinostomy (DCR) is an effective and safe procedure for patients with post-saccal obstruction of the nasolacrimal pathway. The aim of DCR is to relieve symptoms by creating a bypass between the lacrimal sac and the nasal cavity. The most common reason for failure is stenosis caused by a fibrotic process at the rhinostomy site. In this prospective study we assessed the expression of heat shock protein 47 (HSP47), a regulator of fibrosis, in the biopsies of nasal mucosa isolated from patients undergoing primary endoscopic DCR (EN-DCR)., Methods: Thirty consecutive primary EN-DCR procedures in 30 patients were performed using the powered instrumentation technique. The nasal mucosa specimens over the rhinostomy site were collected for histological analysis at the beginning of the operation and the expression of HSP47 was evaluated by immunohistochemistry. The outcome of EN-DCR was estimated in follow-up visits at 1 week, 2 months and 6 months after surgery., Results: At the 6-month follow-up, the overall success rate after primary EN-DCR was 83%. A metaplastic change and strong expression of HSP47 in nasal mucosa were associated with EN-DCR failure (p = 0.009)., Conclusions: HSP47 may be regarded as a novel marker to predict impaired EN-DCR outcome., (© 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.)

Objectives: To evaluate apparent diffusion coefficient (ADC) in cerebellar subregions in patients with stroke., Materials and Methods: The total counts and ADCs were bilaterally measured on cerebellar white matter, gray matters of medial (G1), intermediate (G2), and lateral zones (G3) on SPECT and ADC maps from 20 patients with supratentorial ischemic stroke within the first 48 h and on day 8 after onset. ADCs were also obtained from 15 age-matched controls., Results: Within 48 h, the ADCs were significantly increased bilaterally in the G3, and tended to be increased bilaterally in the white matter and G1, and contralateral G2 compared with controls. On day 8, the ADCs were significantly increased in all contralateral cerebellar subregions and in ipsilateral G1 and G2, and tended to be increased in ipsilateral G3. The ADC value was significantly higher in contralateral than in ipsilateral white matter on day 8. The interhemispheric asymmetry indices (AIs) of ADC and SPECT were significantly associated with each other in G2 and G3 within 48 h, but not on day 8. The AIs of ADC and SPECT were significantly related to each other in the G3 within 48 h and on day 8., Conclusions: Supratentorial ischemic stroke may cause mild cerebellar vasogenic edema., (Copyright © 2009 The Authors. Journal compilation © 2009 Blackwell Munksgaard.)

Objectives/hypothesis: Early recovery and pain management after endoscopic sinus surgery (ESS) are largely unexplored regardless of the large number of ESSs performed by otorhinolaryngologists. In the present study, we evaluated whether scheduled administration of acetaminophen (paracetamol) for pain management after ESS would allow faster recovery to normal daily activities compared with acetaminophen administered on an as needed basis., Study Design: Open, prospective, randomized, controlled clinical trial with two parallel groups., Methods: There were 78 patients who were undergoing ESS and were randomized into two groups. The "scheduled" group (n = 38) was instructed to take two acetaminophen 665 mg modified-release tablets three times a day during the first five postoperative days, whereas the "as needed" group (n = 40) was given instructions to use acetaminophen 665 mg tablets only on an as needed basis. Patients filled in a questionnaire at the follow-up visits on the 7th and 30th postoperative days. The main outcome measures were return to normal daily activities (primary endpoint) and pain during the first week after surgery and patients' satisfaction with pain management (secondary endpoints)., Results: Patients returned to their normal daily activities in 8.8 (SD 4.8) days in the "scheduled" group versus in 10.3 (SD 7.0) days in the "as needed" group (mean difference 1.5; 95% CI of the difference -1.3 to 4.2; P = .29). In the "scheduled" group, the mean of worst pain was 3.4 (2.9) compared with 5.2 (3.0) in the "as needed" group on an 11-point scale (mean difference 1.7; 95% CI of the difference 0.4-5.2; P = .019). The patients in both groups were equally satisfied with pain management., Conclusions: The present study suggests that patients recover in 9 to 10 days after ESS when provided with appropriate pain management. Our data indicate that by prescribing scheduled acetaminophen, postoperative pain after ESS can be controlled effectively without the need for opioid analgesics.

Objectives/hypothesis: Endoscopic sinus surgery (ESS) is increasingly performed by otorhinolaryngologists. However, the early recovery and pain management after ESS is still largely unexplored. In the present study, we have evaluated the incidence and severity of pain and the efficacy and safety of acetaminophen (paracetamol) for pain management in patients undergoing ESS., Study Design: The authors conducted a prospective, double-blind, placebo-controlled clinical trial., Methods: Seventy-four patients with ESS were randomized to receive either 1 g intravenous acetaminophen (Perfalgan) (n = 36) or 0.9% normal saline as a placebo (n = 38) after ESS was performed under local anesthesia. No other analgesic medication was permitted during the study. Need for rescue analgesic during the first 4 hours after surgery as well as all adverse events were recorded., Results: Most patients, 27 of 38 (71%), in the placebo group needed rescue analgesics but significantly fewer patients in the acetaminophen group required rescue analgesia, i.e., only nine of 36 (25%) patients needed oxycodone. The worst pain after surgery was also more severe in the placebo group than that in the acetaminophen group. There was no significant difference between groups in the incidence of adverse events. The most common adverse events were vomiting, nausea, and headache., Conclusions: ESS is associated with significant postoperative pain. Acetaminophen provides adequate pain relief in most patients who have undergone ESS. However, the analgesic efficacy of acetaminophen alone is insufficient in some patients, and hence all patients with ESS must be followed closely to identify those patients in need of more efficient analgesia during the early phase of recovery.

Objectives: We examined whether the apolipoprotein E (ApoE) allele epsilon4 influences imaging findings in stroke as assessed by diffusion- (DWI) and perfusion-weighted (PWI) magnetic resonance imaging, and MR angiography (MRA)., Methods: Eight ApoE epsilon4 carriers and 15 non-carriers with acute ischemic stroke in the anterior circulation underwent DWI, PWI, and MRA within 24 h of stroke. DWI and PWI were repeated a week later. The apparent diffusion coefficient, relative cerebral volume (rCBV), relative cerebral blood flow (rCBF) and relative mean transit time were measured in three subregions on day one., Results: In the ischemic core and the area of infarct growth, rCBV values were significantly higher in the epsilon4 carriers compared with the non-carriers. Based on the MRA findings, collateral blood flow was better in the epsilon4 carriers than in the non-carriers. Under the comparable severity of hypoperfusion, the hypoperfused area proceeded to infarction later or did not proceed to infarction at all in the non-carriers., Conclusion: These preliminary data suggest that in the ApoE allele epsilon4 carriers the threshold for the brain tissue to survive hypoperfusion versus to proceed to infarction seems to be different from that of the non-carriers.

Objectives and Methods: This study investigated the ease with which 52 Parkinson's disease patients already receiving adjunct entacapone to traditional levodopa were switched to Stalevo (levodopa/carbidopa/entacapone)., Results: The switch to Stalevo was straightforward for most patients taking standard-release levodopa with 86% of these patients being able to replace their entire regimen without having to change the amount of levodopa taken. The majority of patients (54%, P = 0.162) preferred Stalevo; 31% preferred their prior treatment regimen; 15% had no preference. Patients found Stalevo more simple to dose (94%), more convenient to use (84%), easier to handle (84%), easier to remember (67%) and easier to swallow (59%), compared with their previous medication., Conclusions: Stalevo was well tolerated, with a low incidence of adverse events. The study shows that Stalevo is an effective, preferred and well-tolerated means of delivering levodopa/carbidopa/entacapone in one easy-to-use tablet.

Objectives: To assess the correlation of diffusion-weighted (DWI) and perfusion-weighted imaging (PWI) findings with the severity of acute neurologic deficit and their ability to predict short and long-term clinical outcomes of stroke. The ability of DWI and PWI to predict the outcome was compared with the ability of clinical stroke scales to predict the outcome., Methods: Forty-eight patients with acute stroke underwent diffusion DWI and PWI on the first and eighth day after the ictus. Clinical and functional scales were carried out before each scan and 3 months after the stroke., Results: The volumes of both the DWI and the PWI lesions correlated well with the acute neurologic deficit and the final outcome. The first day PWI (r = 0.64) and the National Institutes of Health Stroke Scale (NIHSS) scores (r = 0.70) correlated well with the final outcome. However, in logistic regression analysis, only the NIHSS score at the acute stage was the only independent predictor of the long-term clinical outcome., Conclusion: While the PWI and DWI lesion volumes correlated well with the outcome of the stroke, the imaging measurements did not improve the prognostic power over plain clinical stroke scale scores.

Objectives/hypothesis: Although most studies have agreed that small mastoid air cell systems correlate with long-standing otitis media, the extent to which the environmental factors affect the development of MACS remains undetermined. We investigated the radiographic development of mastoid air cell systems in children with recurrent acute otitis media or otitis media with effusion who were treated with ventilation tubes early in life., Study Design: Prospective follow-up., Methods: Of 305 consecutive patients aged less than 17 months with recurrent acute otitis media or otitis media with effusion who received primary tympanostomy in the Central Hospital of Central Finland, 281 (92.1%) were followed for 5 years. Mastoid radiographic films were obtained preoperatively and at the 5-year end-point examination. Mastoid air cell system size was planimetrically measured., Results: Small baseline mastoid air cell system size was associated with young age at the time of first diagnosis of otitis media and small size of the child. Slow growth and small final size of mastoid air cell system related significantly with female gender and with slow overall growth of the child. Slow mastoid air cell system growth was observed in children who required several ventilation tubes during the follow-up period. Small final mastoid air cell system size correlated significantly with unfavorable otological outcome., Conclusion: The genetically determined development of mastoid air cell system is arrested in varying degree by environmental factors, particularly by an early onset of otitis media, a long-standing disease, and an unfavorable otological outcome. On the other hand, poor pneumatization seems to be a risk factor for chronic and recurrent infections and, ultimately, for a deficient otological outcome. However, in a vast majority of patients, this untoward development may be reversed by an early and, if needed, repeated tympanostomy.

Objective: To investigate the expression of inducible nitric oxide synthase (iNOS) in oropharyngeal and hypopharyngeal squamous cell carcinoma (SCC) and its relation to p53 expression, histologic differentiation, clinical data, and prognosis., Study Design: A retrospective survey., Methods: Primary tumors for analyses were obtained from 118 patients diagnosed with SCC of the oropharynx or hypopharynx between 1975 and 1998 in eastern Finland. Immunohistochemical analysis was used to evaluate the expression of iNOS and p53. The expression pattern of iNOS was related to p53 expression, clinical data, and survival., Results: High iNOS score was associated significantly with high nuclear p53 expression index (P = .006) and positive cytoplasmic p53 expression (P = .025). The score for iNOS expression was significantly lower in the largest (T4) tumors (P = .043). No association was seen between iNOS score and N or M class, tumor stage, or histologic differentiation. The score for iNOS expression was not related to overall survival., Conclusions: The expressions of iNOS and p53 seem to be inter-related in pharyngeal SCC, although the causality remains to be clarified. The expression of iNOS shows no prognostic value in pharyngeal SCC.

Objective: Ventilation tubes in the treatment of otitis media in young children remain controversial. Despite abundant research, few prospective long-term follow-up studies have included even a minority of patients under 1 year old. We investigated long-term otological and audiological outcomes in children with recurrent acute otitis media and otitis media with effusion, who were treated early with ventilation tubes., Study Design: Prospective follow-up., Methods: Three hundred five children under 17 months of age received a primary tympanostomy in the Central Hospital of Central Finland (Jyväskylä, Finland), and those 281 (92.1%) who were monitored prospectively for 5 years made up the study group. At the final examination, pneumatic otoscope and otomicroscope were used and pure-tone audiometric thresholds of air and bone conduction were measured to define the hearing levels (mean of 0.5, 1.0, and 2.0 KHz thresholds)., Results: Of ears, 67.3% were healed, 7.1% had a retraction of tympanic membrane in pars flaccida and 9.6% in pars tensa, 7.5% had an ongoing otitis media with effusion, 3.9% had a ventilation tube in place, and 4.6% had a tympanic membrane perforation with mean hearing levels of 7.6, 9.0, 16.0, 18.5, 10.5, and 17.7 dB, respectively., Conclusions: Hearing in general was well preserved, and no ear presented with adhesive otitis media or cholesteatoma. Adverse otological and audiological outcomes of these young children did not exceed those presented by others for older counterparts. Tympanic membrane perforations, ongoing otitis media with effusion, and pars tensa retractions were causes of mild conductive hearing loss. Because one third of ears continued to have middle ear disease or sequelae, we emphasize the proper follow-up and restoration of middle ear ventilation with repeat ventilation tubes if not otherwise achieved.

Objective: To evaluate recovery after tonsillectomy and safety and efficacy of ketoprofen in pain treatment after discharge., Study Design: A prospective, longitudinal study of 102 patients undergoing tonsillectomy., Methods: All patients underwent tonsillectomy (or adenotonsillectomy) under general anesthesia. In the hospital, 77 patients received a bolus of 0.5 mg/kg ketoprofen intravenously, followed by a 3-mg/kg continuous infusion over 24 hours, and oxycodone for rescue analgesia. Twenty-five patients received normal saline and oxycodone. At discharge, all patients were prescribed ketoprofen capsules at a dose of 3 to 5 mg/kg per day for postoperative pain control at home, with paracetamol-codeine tablets for rescue analgesia. At home, the patients recorded pain and analgesic consumption each day for the first week after surgery. At 3 weeks, patients recorded the total analgesic requirement, duration of pain, all adverse events during recovery, and return to normal daily activities., Results: No pre-emptive effect of ketoprofen was noticed because there was no significant difference in recovery after discharge between patients who had received ketoprofen or placebo during the first 24 hours after surgery. In the whole study group, the median of pain cessation was 11 days (range, 3-24 days) and the median of analgesic treatment was 12 days (range, 5-25 days). More than 50% of the patients needed 1 to 3 rescue analgesic doses daily during the first week after tonsillectomy. A return back to normal daily activities took place after 12 days (range, 2-24 days). Nine patients needed electrocautery to stop postoperative bleeding. No other serious adverse events occurred., Conclusions: The main problem after tonsillectomy is significant pain that can last 11 to 12 days after surgery. Ketoprofen combined with paracetamol-codeine provided sufficient analgesia for most patients at home, but because ketoprofen may cause an increase in the secondary hemorrhage rate, it should be prescribed with caution.

A population-based survey was conducted in 35 municipalities in Northern Finland to assess the incidence of lip cancer as well as the patient and tumour characteristics in cases diagnosed between 1983 and 1997. A total of 96 new patients emerged. The age-standardised incidence (per 100,000 years) of lip cancer in men decreased from 4.8 in 1983-1987 to 1.4 in 1993-1997. The incidences in women were 0.30 to 0.36, respectively. The median age of the patients increased from 66 to 73 years through the years. Overall, 90% of the patients had at least one of the known risk factors, namely rural domicile, outdoor occupation or smoking. The median duration of symptoms also remained the same, as did the median size and location of the tumour at diagnosis. In contrast, spread to regional lymph nodes became rare during the period.

Objectives: To assess the prevalence of Meniere disease in the population of 5 million in Finland according to the criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) recommendation., Study Design: Retrospective investigation based on patient records of 306 patients treated for Meniere disease and recognized as such according to the International Statistical Classification of Diseases and Related Health Problems (ICD-9 or ICD-10) in seven Finnish hospitals serving a population of 1.5 million people., Methods: Patients were selected from the computerized patient registers of outpatients and inpatients having received an appropriate diagnosis during the period from 1992 to 1996 and re-evaluated. Definite cases according to AAO-HNS guidelines were identified to calculate the prevalence of Meniere disease in Finland at the end of 1996., Results: A total of 131 definite cases of Meniere disease were identified. The prevalence of at least 43 per 100,000 and an average annual incidence of 4.3 per 100,000 were obtained. The prevalence turned out to be higher (P<.001) in Northern areas (49/100,000) than in the south (38/100,000). The prevalence did not differ in the areas of university hospitals (44/100,000) from those of central hospitals (42/100,000)., Conclusions: The prevalence and incidence in Finland is lower than could be expected from previous international surveys, most of which provide inadequate data for forming a real picture of the epidemiology of Meniere disease. Uniform diagnostic criteria are indispensable for further research.

The structure and function of ciliated epithelium were studied in 44 human nasal mucosa samples using a photoelectric method and scanning electron microscopy (SEM). The ciliary beat frequency (CBF) of cases with recurrent or chronic sinusitis was 9.1 +/- 5.4 Hz. In eight of the samples (18.2%) no ciliary activity was detected. The amount of ciliated cells, the orientation of cilia, epithelial metaplasia, and secretion were found to be explanatory factors accounting for the decreased ciliary activity. Ciliary disorientation and a lack of ciliated cells in SEM correlated with low ciliary activity. In cases where sinusitis secretion was not seen, the CBF was slower than in cases with mucus or mucopurulent secretion. Sinusitis with disoriented cilia, a loss of ciliated cells, and a lack of mucosal secretion is associated with a decreased CBF. This may lead to impaired mucociliary clearance and increase the risk of recurrent and chronic sinusitis.

Several methods have been devised for measuring the nasal mucociliary transport rate (N-MTR), but only one side of the nose has usually been studied. This study was conducted to determine whether there are side-to-side differences in N-MTR. A radioisotopic method was used to investigate 185 patients with various respiratory symptoms. Bilateral measurements were performed in the 111 patients with an N-MTR of under 7 mm per minute. In 16 healthy control subjects, the N-MTR ranged from 5.0 to 14.6 mm per minute (mean: 7.8 mm per minute) in the better nostril and from 1.2 to 11.0 mm per minute (4.3 mm per minute) in the poorer nostril (P<.001). In the 111 patients, the N-MTR ranged from 0.0 to 12.0 mm per minute (3.5 mm per minute) in the better nostril and from 0.0 to 9.5 mm per minute (1.7 mm per minute) in the poorer nostril (P<.001). In the control subjects, the mean N-MTR was better (P=.011) in the decongested nostril. Even when the N-MTR was less than 5 mm per minute on the first measured side, it was normal on the opposite side in 18.9% of patients and in 18.8% of control subjects. The author concluded that if the N-MTR is impaired in one nostril, it should also be measured in the opposite nostril.

1. The rat and the guinea-pig are commonly used animals when the effects of drugs on ciliary activity in respiratory airways are studied. There are few data concerning the possible differences in ciliary function between these two animals. 2. Using a photodetector method we measured the ciliary beating frequency (CBF) from the upper part of the trachea, the lower part of the trachea and the distal part of the main bronchi (subsegmental bronchi) of rat and guinea-pig respiratory tract. In addition, the structure of the cilia was studied using scanning electron microscopy (SEM). 3. CBF in the rat respiratory tract was significantly lower than in the guinea-pigs. In the upper trachea, the CBF for rat was 12.7 beats/s and 15.3 beats/s for guinea-pig. The respective values were 9.2/16.0 beats/s in the lower part of the trachea and 6.9/13.8 beats/s in subsegmental bronchi. In both rats and guinea-pigs CBF was lower in the subsegmental bronchi than in the trachea (rat: 25.0-45.7%, guinea-pig: 9.8-13.8%). 4. In addition to higher CBF, the quality of the photo-electrical signal was better from guinea-pig tissues, probably as a result of the larger amounts of ciliated cells and longer cilia of guinea-pig respiratory epithelial compared to those in rat mucosa. 5. SEM showed that the rat cilia were on average shorter (3.6 vs 4.3 microns) and thinner (0.19 vs 0.22 microns) than those of the guinea-pig. Rat mucosa was markedly less ciliated than the respiratory mucosa of the guinea-pig.(ABSTRACT TRUNCATED AT 250 WORDS)

A randomized prospective study was performed to compare the recovery in 41 patients undergoing uvulopalatopharyngoplasty (UPPP) with either propofol-nitrous oxide-fentanyl or thiopentone-isoflurane-nitrous oxide-fentanyl anaesthesia. The patients were referred to UPPP after examination including polysomnography and otorhinolaryngological examination. The propofol group received propofol 2 mg.kg-1 for induction followed by an infusion of 10 mg.kg-1.h-1 after intubation. The thiopentone-isoflurane group received 5 mg.kg-1 of thiopentone for induction followed by isoflurane (0.5-2%) after intubation. Other medication was similar in both groups. In the propofol group the patients had a significantly better oxygen saturation during the first postoperative hour (P < 0.05), and a higher rate of breathing (P < 0.05), indicating a more rapid recovery of the physiologic control of breathing. Pain as measured by visual analogue score was lower (P < 0.05) during the second postoperative hour compared with the isoflurane group. Apneic episodes occurred with similar frequency in both groups, and they were related to the severity of obstructive sleep apnea (OSA). We conclude that propofol is preferable to thiopentone-isoflurane in UPPP operations, because physiologic respiratory control recovers faster and postoperative pain is less intense.

The Kuopio Regional Institute of Occupational Health, in collaboration with the Social Insurance Institution and the National Board of Health, conducted and evaluated a national model for the farmers' occupational health services. In January 1985 the National Board of Health instructed the Finnish municipal health centers to start the provision of farmers' occupational health services based on the recommendation given by the research group. The service was evaluated by experiments carried out during 1982, 1985, and 1986. The main problem in function of the services was that the health hazards (exposures) were difficult to observe and evaluate. The system of how the occupational health nurse evaluates the working conditions should be further developed. The efficiency of the services was studied by postal inquiries in 1982 and 1986. Farmers' knowledge about the appropriate means of reducing hazardous exposures had increased significantly due to the occupational health services. At the local level, the main problem in providing services for occupational farmers is that health centers do not have the resources to offer services for all farmers at the same time. Altogether by the end of 1986, about 30% of all active farmers in Finland (45,000 farmers) were willing to have occupational health services, which is voluntary for self-employed farmers.

Bovine epithelial and urine antigen extracts were compared using enzyme-linked immunosorbent (ELISA) inhibition assay and sodium-dodecyl-sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) with immunoblotting. According to ELISA inhibition results, the two extracts share about 2% of their antigenic components. Urine-derived antigens seem to be antigenically closer to serum proteins than epithelial antigens, as determined by rabbit immune sera. The IgG responses of allergic farmers against epithelial antigens were directed mainly against a protein of 20 kD, while non-allergic farmers had only very weak reactions. Generally, the IgG response against urinary antigens seemed to be more heterogeneous than against epithelial antigens. Almost all cow-allergic farmers reacted with a band at 20 kD in IgE immunoblotting against urinary and epithelial antigen while all non-allergic farmers showed negative results.

A rare case of angioleiomyoma in a 76-year-old man is presented. The main symptoms were hoarseness and dyspnea. The tumor originated in the subglottic surface of the right vocal cord and there was only 3 mm of the laryngeal inlet free of the tumor. Histopathologically it was well circumscribed and composed of proliferating smooth muscle fibers and dilated blood vessels. The tumor was partially removed endoscopically, and subsequent cryotherapy was instituted. After two courses of cryotherapy the tumor had completely disappeared. Laryngeal function was restored to normal, and no signs of recurrence were observed after follow-up of 8 months.

A rare case of bilateral vocal cord paralysis after orotracheal intubation and inhalation anesthesia, in surgery not in relation to the neck, is presented. There was no obvious cause for the paralysis and possible etiological factors are discussed. Overextension of the neck during intubation is suspected of being the etiological agent causing stretching of both the vagus nerves. Normal laryngeal function returned after two months.