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Biomedical subjects

Wolfgang Pirsig

Publications and source records attributed to Wolfgang Pirsig.

16 recordsLinked to original sources
PubMed2006

Early depictions of the human anterior nasal septum.

In the literature, remarks on the depiction of the anterior nasal septum in prehistoric times cannot be found. Studying works of art from some archaeological sites of Asia, Asia Minor, Near East, Egypt, and Southeastern Europe the anatomical depiction of the columella and the nostrils in human figures are shown. These figures or heads, partly appearing as masks, were made of ivory, stone, marble, terracotta, steatite, reeds and clay, or of burned limestone. Faces and figures sculpted in the time between the Upper Palaeolithic (30,000 - 25,000 BC) and the Early Bronze Age (3,300 - 2,400 BC) are presented as examples of our ancestors' outstanding skill to create works of art with an astonishing ability to observe anatomical details. The tendency to create a human nose in a natural manner can already be recognized in the figurines of the Upper Palaeolithic.

History, Ancient↗
PubMed2004

Reconstruction of anterior nasal septum: back-to-back autogenous ear cartilage graft.

OBJECTIVES/HYPOTHESIS: The ideal material for reconstructing the nasal septum in the deficient nose has not been found. Since 1986, the authors have used autogenous cartilage from the cavum conchae to successfully correct the anterior septum and the associated cartilaginous saddle. The long-term results in 26 patients with a destroyed septum and a saddle nose are reported. STUDY DESIGN: Retrospective study. METHODS: The mean age of the patients at surgery was 40.2 years, and the mean number of previous nasal procedures was 1.6. Because 11 patients had septal perforations and insufficient septal cartilage or bone, ear cartilage grafts from the cavum conchae were harvested through an anterolateral approach. A special incision was used to divide the concave ear cartilage while preserving the posterior perichondrium. This produced a stable, balanced back-to-back graft. The graft was 2.5 to 3 cm long, long enough to allow reconstruction of the anterior septum and to correct part of the saddle nose deformity. The rest of the conchal cartilage was used to fill the remaining cartilaginous saddle. Follow-up investigations included photographs and visual analogue scales of the patients' symptoms and satisfaction. RESULTS: After a mean interval of 36.7 +/- 22.3 months, the back-to-back grafts showed no macroscopic signs of resorption. Graft position and shape remained intact after transplantation. All noses were adequately projected and mobile. All patients but one were satisfied with the functional and esthetic result. With a score of 4 representing the level of satisfaction as "very good," the mean score of the patients was 3.2 +/- 0.79. The saddle of the nose completely disappeared in 65.4% of patients, was minimally visible in 23.1%, and was slightly present in 11.5%. Nasal breathing improved considerably in 21 patients, remained the same in 4 patients, and worsened in 1 patient. The mean score of all patients for nasal breathing was 7.3 +/- 1.87 on a visual analogue scale of 0 to 10, with 10 representing satisfaction as "very good". CONCLUSION: The back-to-back autogenous ear cartilage graft is a viable, stable, and balanced graft for functional and aesthetic reconstruction of the anterior nasal septum and cartilaginous saddle deformity in patients with a severely traumatized and deficient septum.

Adolescent↗
PubMed2004

Antrochoanal polyp and obstructive sleep apnoea in children.

Antrochoanal polyps were first documented in the 18th century. They represent one of the most common types of nasal polyps in children without cystic fibrosis. Only a few reports on children who had a history of snoring due to an antrochoanal polyp and only two cases where the antrochoanal polyp caused documented obstructive sleep apnoea (OSA) have been published so far. This report adds a third case of paediatric OSA induced by an antrochoanal polyp in a 12-year-old boy. After endonasal endoscopically-controlled polypectomy and a recurrence, transoral osteoplastic antrotomy in combination with endoscopic endonasal polypectomy eliminated the antrochoanal polyp and OSA was resolved. The authors have reviewed essential historical aspects about children suffering from snoring and/or OSA caused by an antrochoanal polyp.

Child↗
PubMed2003

Recent developments in the treatment of obstructive sleep apnea.

Modern sleep medicine has been in existence for only 20 years and therefore has to be regarded as a comparatively recent field of specialization. For this reason it is not surprising that there are numerous new trends and developments concerning the treatment of sleep-related breathing disorders. This review focuses on developments in the treatment of obstructive sleep apnea (OSA) over the last 5 years.The review is based on a Medline bibliographic search using the key words 'treatment', 'obstructive sleep apnea' and 'sleep-related breathing disorders' and covers papers published since 1997, including references in these articles. In respect to conservative treatments the following important developments were found. Oral devices were shown to be effective in about 50-70% of patients with OSA, but at this stage it is not possible to predict in which patients successful treatment can be expected. As subjective compliance averages only about 50%, thermoplastic devices used as trial devices provide a reasonable alternative to reduce costs. Automatic continuous positive airway pressure (CPAP) units have been shown to cut costs when used for pressure titration in severe sleep apneics during the day or when used in so-called split-night procedures in appropriate cases. Nasal CPAP has proven to be effective in children, showing higher compliance rates than in adults. The development of mouth-pieces provides the possibility of using CPAP orally, e.g. after nasal surgery. Electrical stimulation of the tongue muscles shows promising preliminary results. Nevertheless, further research in this field is necessary. In the field of surgery, the most valuable development has been tissue reduction using radiofrequency energy, which has been shown to be effective and minimally invasive. Other fundamentally new surgical techniques have not been attempted within the last 5 years; instead, development in this area appears to be defined by a combination of previously known methods (so-called multilevel surgery) and optimized methods of patient selection. Such combined surgical procedures has achieved success rates of about 70%. Taking all these developments into account, CPAP therapy remains the gold standard for treatment of patients with OSA; yet the low long-term compliance rates of 60-70% have to be regarded as a major challenge warranting further effort.

Adolescent↗
PubMed2003

The nose and sleep-disordered breathing.

The influence of nasal obstruction on the pathogenesis of sleep-disordered breathing (SDB) has not yet been clearly defined. Similarly, a lack of data about the long-term effect of nasal surgery on snoring and obstructive sleep apnea keeps discussion of this topic controversial. This special issue of Sleep and Breathing presents four review articles that try to elucidate the complex interrelationship between the nose and SDB. An outstanding review article opens our eyes to the fascinating palette of the activities of nitric oxide, focusing on its inseparable connection to obstructive sleep apnea. Another summarizes data on the role of the nose in the pathophysiology of SDB and the slow progress concerning rhinologic treatments for SDB. The part of nose in the diagnostics of SDB is treated in a third article that also focuses on acoustic reflectometry as the newest technical development in the diagnostics of SDB. The last article elucidates the effect of nasal continuous positive airway pressure on the nasal passages including the authors' own data on the relatively poor long-term compliance of nasal continuous positive airway pressure.

Humans↗
PubMed2003

Impact of impaired nasal breathing on sleep-disordered breathing.

OBJECTIVE: The role of the nose and its importance in the development and severity of sleep-disordered breathing (SDB) is still a matter of discussion. In the first part of this study, often-controversial data and theories about the nose are reviewed concerning its influence on the pathophysiology of SDB and to interpret certain clinical findings connected with impaired nasal breathing. In the second part, the effectiveness of some nonsurgical and surgical therapies is evaluated. METHOD: A worldwide literature research (Medline) was the basis for this review. RESULTS: The study of the literature on nasal resistance and clinical findings about the effects of incomplete or complete nasal blockage, particularly in comparison of healthy persons and persons with SDB, allows the assumption of the existence of two different groups of responders: a larger group where the importance of the nose for SDB is negligible and a smaller group where the influence of the nose on SDB is crucial. The same seems to hold true for the responses to nonsurgical and surgical treatments with only a few surgical results available in the literature. While the success rate of nasal surgery for patients with obstructive sleep apnea, for instance, seems to be less than 20%, the normalization of nasal resistance often leads to a positive impact on the well-being and the sleep quality of these patients. However, because criteria to identify responders are lacking, the prediction of success of any treatment for the individual with SDB is not possible.

Anti-Inflammatory Agents↗
PubMed2002

Upper airway epithelial structural changes in obstructive sleep-disordered breathing.

The etiology of upper airway collapsibility in patients with snoring and obstructive sleep apnea (OSA) remains unclear. Structural mucosal changes could be contributory factors. The objective of this study was to determine whether pathologic changes in the epithelium or the epithelial-connective tissue interface are present in patients with snoring and/or OSA by means of scanning electron microscopy and immunohistochemistry. Uvulae were obtained by uvulopalatopharyngoplasty from three patients with habitual snoring and nine patients with mild to severe OSA, as well as by dissection from 43 nonsnoring body donors. Scanning electron microscopy revealed structural changes in the epithelial-connective tissue boundary that significantly differed from age-related changes in the control subjects. The immunohistochemical staining with antibodies against epithelial cytokeratins showed differences in the expression pattern of cytokeratin 13 between patients and control subjects. No differences were found in the distribution pattern of laminin. Analysis of defense cells revealed a significant diffuse infiltration of leukocytes, mainly T cells, inside the lamina propria of the patient group, which was not observed in the control group. In conclusion, these results support the hypothesis that progressive structural changes in the mucosa caused by the trauma of snoring are a possible contributory factor to upper airway collapsibility.

Adult↗
PubMed2002

Effect of nasal surgery on sleep-related breathing disorders.

OBJECTIVE/HYPOTHESIS: Single cases of patients who have experienced obstructive sleep apnea (OSA) and who recovered completely after nasal surgery have been described in various studies. The purpose of this study was to evaluate the efficacy of only nasal surgery 1) in a group of patients with obstructive sleep apnea and 2) in simple snorers. STUDY DESIGN: A prospective, controlled study with 26 adult patients who underwent nasal surgery as single treatment of their sleep-related breathing disorders. The cases were evaluated based on the severity level of their preoperative Apnea Hypopnea Index (AHI). MATERIAL AND METHODS: Between August 1996 and July 2000, 26 patients who snored and had impaired nasal breathing underwent attended polysomnography in the sleep laboratory as single treatment nasal surgery was performed. Postoperative polysomnographic findings and complications were reviewed. RESULTS: Nineteen of 26 patients (73.1%) were diagnosed as having OSA. Seven patients were simple snorers with an AHI below 10. The surgical response rates, defined as greater than or equal to 50% reduction in the postoperative AHI and a postoperative AHI of less than 20, was 15.8% in the apneics. For the whole group, the AHI decreased postoperatively from 31.6 to 28.9. However, daytime sleepiness improved significantly and arousals decreased significantly in both apneics and simple snorers after nasal surgery. CONCLUSIONS: We conclude that nasal surgery has a limited efficacy in the treatment of adult patients with sleep apnea. Nevertheless, nasal surgery significantly improves sleep quality and daytime sleepiness independent of the severity of obstructive sleep-related breathing disorders.

Adult↗
PubMed2002

Early depictions of the nasal turbinates in the 15th century.

Although nasal turbinates had already been described by Hippocrates, it was not until the 15th century that they were depicted. The inferior turbinate was shown for the first time rather true- to nature in the works of the Middle Rhenic Master circa 1450-1460 and Leonardo da Vinci in 1489. The posterior ends of the middle turbinates were depicted on a woodcut by Georg Thomas for Dryander's "Anatomiae ... pars prior" in 1536. These and a few other examples show that some artists were ahead of the medical profession in demonstrating anatomical details in the 15th and 16th century.

Anatomy, Artistic↗
PubMed2002

Early depictions of the nasal turbinates in the 15th century.

Although nasal turbinates had already been described by Hippocrates, it was not until the 15th century that they were depicted. The inferior turbinate was shown for the first time rather true-to nature in the works of the Middle Rhenic Master circa 1450-1460 and Leonardo da Vinci in 1489. The posterior ends of the middle turbinates were depicted on a woodcut by Georg Thomas for Dryander's "Anatomiae ... pars prior" in 1536. These and a few other examples show that some artists were ahead of the medical profession in demonstrating anatomical details in the 15th and 16th century.

History, 15th Century↗
PubMedDate not supplied

Singing and evil in visual art.

Surprisingly, singing and music sometimes are connected with poor or even lethal outcomes. One example is personified in the legend of Orpheus, who through the power of his songs, succeeded in leading the wild Thracians into the Greek religion. This did not save him, however, from being murdered by Thracian women probably because of his paedophilic tendency. The scene has been illustrated since 490 BC on Attic red-figure vases. The Sirens, with the body of a bird and the head of a female and dwelling in the Sicilian Sea, were creatures who attracted sailors by their song and devoured the unhappy wretches who had been unable to resist their seductive singing. This topic has also been depicted on ancient Greek vases as part of the Odyssey. The idea that beautiful singing with an instrument can also be a symbol of sin and a sign of the devil is deeply rooted in Christian thinking. This aspect of music as the power of evil is extensively depicted in Dutch and Flemish genre paintings where singing and playing string instruments were also common symbols of lust and vices, seduction and, therefore, moral decay. Some examples of the power of evil in singing in representative art are presented in this article.

Culture↗