Biomedical subjects

P A Clement

Publications and source records attributed to P A Clement.

At least 19 recordsLinked to original sources

PubMed1991

The use of a rigid nasal endoscope in children--with special interest in the middle meatus.

Forty children (1-12 years) underwent under general anesthesia a nasal endoscopy, prior or after adeno(tonsillec)tomy and/or the insertion of ear grommets. The endoscopy was mainly performed with a rigid pediatric endoscope (Wolf Company panoview 25 degrees angle; phi 2.7 mm). All data were recorded on video. Special interest was taken in examining the middle meatus. The authors evaluated the presence of septal deviations, the type and presence of secretions in the nasal cavity or middle meatus, the shape of the inferior and middle turbinate as well as the aspect of the ethmoidal bulla and uncinate process. Anatomical findings are discussed for different age groups.

Anesthesia, General↗

PubMed1991

The influence of septal deviation and septal surgery on tubal function.

Assessment was made of the influence of a nasal septal deviation and the surgical correction of this deviation on the function of the Eustachian tube. A Tuba-Compliance-Manometric test was performed by Valsalva maneuver. On the basis of the results the authors could say that surgical correction of a nasal septal deviation in order to improve the tubal opening pressure, both on the deviated side and the non-deviated side, is justified.

Eustachian Tube↗

PubMed1990

[The effect of a histamine nasal provocation tests on the results of the tubal compliance manometry test (TCM) in normal study subjects].

The Tubal-compliance-manometric test (TCM) assesses the passive and active tubal opening as well as the equilibration ability. The pressures necessary to open the eustachian tube (ET) are measured while performing the Valsalva maneuver and during swallowing (if needed with added pressure). The equilibration ability is also checked. Subjects with normal tympanometry were twice tested, at an interval of 1 to 2 weeks; 52 ETs (in 28 persons) entered the study. According to a variance analysis (ANOVA), there was no significant difference (alpha = 5%) between the two measurements (the results were time-independent). The mean opening pressures were 610 daPa (SD = 108) during the Valsalva maneuver and 97 daPa (SD = 40) during the swallow test. Nearly 14% of the tubes were considered floppy (unable to maintain a positive pressure). In order to study the influence of mucosal swelling on tubal function, 9 subjects (18 tubes) underwent a TCM before and after a nasal histamine provocation. The opening pressures in both tests were significantly altered (higher) after the provocation (ANOVA; 0.001 less than p less than 0.01). One tube became obstructed and two became floppy. The equilibration ability was not altered. The TCM proved to be of value as an easy, fast and quantitative test for assessing active and passive tubal function.

Acoustic Impedance Tests↗

PubMed1990

CT-scan study of the incidence of sinus involvement and nasal anatomic variations in 196 children.

CT-scan was used to examine rhinosinusitis in the developing sinuses; 196 children aged from 3 to 14 years were selected on the base of their chronic rhinorrhea, nasal congestion and cough. The patients were subdivided into six age groups (3-4, 5-6, 7-8, 9-10, 11-12 and 13-14 years). In the youngest age group, the authors noted maxillary involvement in 63%, ethmoidal involvement in 58%, and even sphenoidal sinus involvement in 29% of the children. Involvement decreased gradually with age, with 10% of ethmoidal and 0% of sphenoidal involvement in the 13-14 years age group. Maxillary sinusitis, however, persisted very frequently in the oldest age group (65%). Frontal involvement seems to become significant at the age of 7-8 years (7%) but it never exceeds 15% (11-12 age group). Septal deviations occurred in 16% of the youngest up to 72% in the oldest age group. The prevalence of bullous conchae increased with age too, although less prominently.

Adolescent↗

PubMed1990

Density of epithelial cells in the normal human nose and the paranasal sinus mucosa. A scanning electron microscopic study.

214 biopsies of mucosa from various sites of the nose and paranasal sinuses were obtained post-mortem and examined using the scanning electron microscope. The density of ciliated cells was increased in the nasal cavity, in the antero-posterior direction. In paranasal sinuses the density of these cells was high, except near the ostium of the maxillary sinus, where the density was decreased by half. Non-ciliated epithelial cells were found in relatively few areas: anterior aspect of the middle and lower turbinates, anterior septum. However, no uniform distribution of these cells was present. The density of goblet cells was significantly lower in the paranasal sinuses as compared to the nasal cavity, with the highest density being found near the ostium of the maxillary sinus.

Aged↗

PubMed1989

Incidence and etiology of rhinosinusitis in children.

The authors discuss the incidence of chronic rhinosinusitis in children. From the study of 196 CT-scans, there follows that as well the ethmoidal as the maxillary sinuses are involved in the young child. In older children, however, the incidence of maxillary sinusitis is more frequent. The etiology of chronic rhinosinusitis is discussed stressing the importance of general factors such as environmental factors, congenital and acquired abnormalities and the influence of drugs, as well as of local factors such as again environmental factors, malformations, and upper respiratory infections. Most of these factors are discussed following personal studies.

Adolescent↗

PubMed1989

Some remarks on nasal polyposis.

After a short historical and literature review the authors present their definition of nasal polyposis. The importance of CT scanning is stressed and the results of a CT-scan study of 350 patients with nasal complaints is presented. The authors discuss the incidence of sinusitis, presence of polypi and nasal anomalies in this population. Furthermore 111 biopsies of nasal polypi were studied and the cellular content, the ducts, glands, veins, aspect of the basal membrane and epithelial layer were described. As an oral ASA provocation test can be hazardous, the authors tested a nasal provocation test with acetylsalicylic acid. Although the test showed some interesting results, the reproducibility was poor. Finally the authors conclude that endoscopy and CT-scanning enable the diagnosis of nasal polyposis in an early stage of the disease.

Aspirin↗

PubMed1989

Nasal provocation with histamine: a comparison of the determination of the threshold of reactivity by three methods of rhinomanometry.

Three methods of rhinomanometry were compared with each other with respect to their ability to determine the histamine threshold (histamine concentration for a 100% increase of the initial total nasal resistance): the active anterior rhinomanometry (P.A.R.). Nasal challenge and consecutive measurement by the three methods of rhinomanometry were conducted in a group of 11 volunteers. The three methods gave significantly different histamine concentration thresholds (p = 0.002). Unilateral histamine thresholds as available from A.A.R. and P.A.R. (at a flow of 250 cm3/sec) did not differ significantly (p = 0.299). For A.A.R. and A.P.R., histamine thresholds were assessed at five different pressure values as well as at five different flow values. The thresholds did not appear to be significantly different at any one of those pressure gradients (p = 0.690) or flow values (p = 0.357).

Clinical Trials as Topic↗

PubMed1989

Recurrent polyposis nasi. Documentation.

After a short historical review a proposal is made for the definition of nasal polyposis. The authors studied 350 CT-scans of patients with nasal complaints. In a high percentage anatomical anomalies were observed. In 57.5% of the CT-scans sinus mucosal disease was visible. In all patients with maxillary sinus disease polyps (rounded structures) could be found; in 31% these polyps were mainly of grade 2. From a retrospective study of 111 biopsies of nasal polyposis (65 patients) it became clear that different polyps from the same patient showed substantial difference in cellular content, i.e. presence of eosinophils, neutrophils, plasma cells, glands, ducti and thickening of the basal membrane. As oral acetylsalicylic acid provocation may be hazardous in ASA-sensitive patients, the authors developed a nasal aspirin provocation test. This nasal ASA test was carried out in 10 normal test subjects, 10 patients with aspecific hyperreactivity, 10 atopic patients and 16 patients with polyposis nasi. The reproducibility of the test, however, was so poor that the nasal ASA challenge test in its present form does not appear to be of any great clinical value. Finally, the authors discuss the physiopathology of nasal polyposis.

Adult↗

PubMed1989

[CAT-scan study of the prevalence of sinus disorders and anatomical variations in 196 children].

CT-scan was used to examine rhinosinusitis in the developing sinuses; 196 children aged from 3 to 14 years were selected on the base of their chronic rhinorrhea, nasal congestion and cough. The patient group was subdivided into six age groups (3-4, 5-6, 7-8, 9-10, 11-12 and 13-14 years). In the youngest age group, the authors noted maxillary involvement in 63%, ethmoidal involvement in 58%, and even sphenoidal sinus involvement in 29% of the children. Involvement decreased gradually with age, with 10% of ethmoidal and 0% of sphenoidal involvement in the 13-14 years age group. Maxillary sinusitis, however, persisted very frequently in the oldest age group (65%). Frontal involvement seems to become significant at the age of 7-8 years (7%) but it never exceeds 15% (11-12 age group). Septal deviations occurred in 16% of the youngest up to 72% in the oldest age group. A prevalence of bullous conchae increased with age too, although less prominently.

Adolescent↗

PubMed1989

[Lens drain versus Donaldson drain: intermediate results of a prospective comparative study of a new versus a classical ventilation tube].

A prospective study was undertaken in which in 72 children a new type of tympanostomy tube, the Lens drain, was inserted in one ear, and a Donaldson drain was inserted in the contralateral ear as a control. The average survival times of both tubes especially seemed to differ significantly: 15.25 months for the new tube, and 10.53 months for the conventional tube (p less than 0.05). By contrast, the relapse rate (20% with the Lens tube versus 27% with the Donaldson tube) after extrusion or extraction, and the residual perforation rate (8% with the Lens tube versus 5% with the Donaldson tube) were not significantly different. Otorrhea was apparently present equally frequently with either tube: 19% with the Lens tube versus 15% with the Donaldson tube.

Child↗

PubMed1988

[Nasal provocation using histamine. A comparison of threshold determination using 3 methods of rhinomanometry].

Three methods of rhinomanometry were compared with each other with respect to their ability to determine the histamine threshold (histamine concentration for a 100% increase of the initial total nasal resistance): the active anterior rhinomanometry (AAR), the active posterior rhinomanometry (APR) and the passive anterior rhinomanometry (PAR). Nasal challenge and consecutive measurement by the three methods of rhinomanometry were conducted in a group of 11 volunteers. The three methods gave significantly different histamine concentration thresholds (p = 0.002). Unilateral histamine thresholds as available from AAR and PAR (at a flow of 250 cm3/sec) did not differ significantly (p = 0.299). For AAR and APR, histamine thresholds were assessed at 5 different pressure values as well as at 5 different flow values. The thresholds did not appear to be significantly different at any one of those pressure gradients (p = 0.690) or flow values (p = 0.357).

Adult↗

PubMed1987

The usefulness of irrigation of the maxillary sinus in children with maxillary sinusitis on the basis of the Water's X-ray.

The authors studied 80 children with sinusitis, all treated with amoxycillin and a decongestive preparation. The authors reached the conclusion that in 30 out of 80 children the third standard X-ray becomes normal without further treatment. In the remaining 50 children the usefulness of irrigation of the maxillary sinus was studied: one group was treated with antroscopy and sinuscopy while the second group did not receive this treatment (control). In both groups control X-rays were performed after three weeks. There was no significant difference between the two groups, which indicates that irrigation does not lead to a better cure. A correlation of 71% was found between X-ray findings and antroscopic findings. As a first treatment antibiotics are recommended.

Anti-Bacterial Agents↗

PubMed1987

The influence of formaldehyde on the nasal mucosa.

In 71 subjects (23 atopic patients, 22 hyperreactive patients and 26 normal test subjects) the authors twice performed a nasal provocation test with formaldehyde in three different concentrations. The test proved to be very much reproducible. There existed no clear-cut significant difference in the threshold for rhinorrhea, sneezing, tearing and pain in the three different groups. The difference in threshold for nasal blockade was very significantly different for the atopic and hyperreactive patients on one hand, and for the normal test subjects on the other hand. After the provocation a small increase in the mucociliary transport time was observed.

Airway Obstruction↗

PubMed1986

[The value of maxillary sinus irrigation in children with maxillary sinusitis using the Waters film].

Eighty children with chronic sinusitis receiving a conservative treatment were followed. They found that without any further therapy the Waters view of 30 children became normal. The usefulness of irrigation of the maxillary sinus was studied in the other 50 children. In one group of 25 children a sinus endoscopy and sinus irrigation was performed. In a control group of another 25 children no further treatment was performed. A comparison between the Waters view and sinus endoscopy is also included in the study. The authors found little difference in the treatment results in the two groups. Furthermore, when the Waters view is normal, then exists little chance of finding a pathological mucous membrane during sinus endoscopy. In doubt the clinical picture is most important. The control of the roentgenogram should be performed one month after the first one. Antroscopy is better for the diagnosis but in view of its traumatic aspect and the finding that it does not result in a better therapeutic response, the authors advise sinus irrigation only in problematic cases.

Anti-Bacterial Agents↗

PubMed1986

[The effect of swimming on nasal patency and tubal function in children. Prospective 24-week cross-over study in 154 children].

This prospective cross-over study involving 154 healthy school children over a time span of 24 weeks revealed a favorable influence of swimming on nasal patency and tubal function in children. The positive influence of bathing on middle ear ventilation seems to be of shorter duration than that on nasal resistance. Tympanogram distribution and nasal resistance are most favorable in girls, older children and in the spring-summer period. A good nasal patency is often associated with a good middle ear ventilation. Advising children against swimming because of sinusitis and otitis is probably not justified.

Acoustic Impedance Tests↗

PubMed1986

[A comparative study of 2 tests for auditory tube function and their effects on swimming].

We studied a group of adults and a group of children. All the test subjects were member of the swimming club and were subjected to an intensive training program for competition swimming. Two easy to perform Eustachian tube tests were compared, i.e. the Bluestone 9 steps test (tympanometry) and the measurement of the opening pressure with a pressure transducer during Valsalva and swallowing. We discuss the advantages and disadvantages of each test and the influence of swimming on the Eustachian tube function in adults and children.

Acoustic Impedance Tests↗

PubMed1985

Histamine threshold and nasal hyperreactivity in non specific allergic rhinopathy.

The authors studied the histamine threshold (endpoint concentration for a 100% pressure gradient increase at a flow of 0.25 liter/second) in a group of 29 patients suffering from non specific allergic rhinopathy and a control group of 15 normal subjects. The result of the nasal challenge was measured with two different methods of rhinomanometry: the passive anterior rhinomanometry (P.A.R.) and the active anterior rhinomanometry (A.A.R.). There existed a slightly significant difference (P less than or equal to 0.05) in histamine threshold between the patient and the control group. The 21 in duplo performed histamine challenges showed the very good reproducebility of the method. Finally, the A.A.R. method turned out to be slightly more sensitive than the P.A.R.-method.

Aerosols↗