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[Endonasal dacryocystorhinostomy: technique and results].

BACKGROUND: Endonasal dacryocystorhinostomy has recently become an important alternative to the classical external Toti procedure. OBJECTIVE: To analyse the outcome after endonasal dacryocystorhinostomy. METHODS: For this purpose 28 of 34 patients treated by endonasal dacryocystorhinostomy between May 1994 and November 1998 were investigated. RESULTS: After an average follow-up of 28 months, 23 of the 28 patients (82%) are free of symptoms. Two additional patients became symptom-free after revision surgery. The total success rate is 89%. The only complications seen were 2 cases of asymptomatic synechiae and one case of mild hyposmia. CONCLUSIONS: Endonasal dacryocystorhinostomy is a rapid, safe, and elegant method for the treatment of post-saccal nasolacrimal duct obstructions.

Dacryocystorhinostomy↗

Recurrent lacrimal sac papilloma: case report.

Tumors of the lacrimal sac are rare. Benign papillomas comprise approximately 40% of all neoplasms of the lacrimal drainage system. They often present insidiously with symptoms of dacryostenosis or dacryocystitis. Recurrent bouts of dacryocystitis and nasolacrimal duct obstruction were reported in a 35-year-old man over a period of 13 years. A medial canthal mass was noted in the 6th year after the onset of symptoms. A tumor was discovered incidentally during surgical intervention for presumed dacryostenosis. Surgical removal of the tumor and dacryocystorhinostomy were performed. The histopathologic report turned out to be benign papiloma. Local recurrences occurred during the follow-up period. In addition to surgical excision, we applied cryotherapy and CO2 laser to prevent further recurrence. This case we presented the characteristic recurrence of lacrimal sac papilloma and implied the possibility of tumor occurrence in a patient with recurrent dacryocystitis. We must bear in mind that a recurrent dacryocystitis may be a presentation of a lacrimal sac tumor, because early diagnosis and aggressive treatment can prevent recurrence and result in a cure.

Adult↗

Topical contrast-enhanced magnetic resonance dacryocystography.

PURPOSE: To evaluate the usefulness of magnetic resonance dacryocystography (MRD) with topical administration of normal saline solution and diluted Gd-DTPA solution for the assessment of lacrimal outflow disorders. MATERIALS AND METHODS: Two T2-weighted sequences and two T1-weighted sequences were evaluated in this study. The 1:100 diluted Gd solution was prepared by diluting Gd-DTPA (Magnevist) with normal saline solution. A phantom study using tube phantoms of various diameters filled with normal saline solution and 1:100 diluted Gd solution was performed. A preliminary study was performed in ten normal volunteers. Eighteen patients with lacrimal outflow disorders underwent clinical MRD, and 14 also underwent conventional dacryocystography (CDG). MRD images were evaluated and compared with clinical symptoms and CDG images. RESULTS: In all sequences, MRD could visualize the full length of 0.7 to 1.7 mm diameter tube phantoms and could show all of the normal lacrimal sacs and nasolacrimal ducts. In the clinical study, MRD findings were compatible with the symptoms in 14 patients but were not compatible with CDG findings in half of the cases. CONCLUSION: Topical contrast-enhanced MRD provided a simple, non-invasive means of obtaining detailed morphological and functional information on the lacrimal drainage apparatus.

Aged↗

Branchio-Oto-renal syndrome: a report on nine family groups.

This study reviews nine new families with branchio-oto-renal (BOR) syndrome (Online Mendelian Inheritance in Man [OMIM] 113650). Diagnosis was made by studying 10 index cases, and then 22 other previously undetected patients were diagnosed within the nine families. The syndrome consists of conductive, sensorineural, or mixed hearing loss; preauricular pits; structural defects of the outer, middle, or inner ear; renal anomalies; lateral cervical fistulas, cysts, or sinuses; and/or nasolacrimal duct stenosis or fistulas. In our study, all patients first diagnosed in each familial group were recognized on the basis of severe renal anomalies associated with at least one of these symptoms. Our study showed that BOR syndrome is a misdiagnosed disorder, usually recognized in the presence of severe renal failure but often not diagnosed, especially in the adult in the presence of other isolated clinical signs, such as mild branchial or urological anomalies. We stress the meticulous search we performed for renal anomalies and/or hearing loss in all subjects showing minimal signs of branchial defects. BOR syndrome should be suspected in all cases of isolated urological anomalies, even if no other signs of the syndrome are present. After BOR syndrome has been diagnosed in a patient, all family members should be examined for the presence of the syndrome, even if there are only minimal stigmata of the disease.

Branchio-Oto-Renal Syndrome↗

Cemento-ossifying fibroma of the orbit.

Cemento-ossifying fibroma presents with ophthalmic symptoms and signs rarely. We report the clinical and pathological findings in a case of cemento-ossifying fibroma of the right maxilla with extension into the orbital floor causing intermittent vertical diplopia, proptosis, and upward displacement of the globe. Compression of the nasolacrimal duct produced epiphora early in the course of the disease. Fibrous dysplasia has often been diagnosed in other cases of benign monostotic fibro-osseous conditions. Ossifying fibroma is easily confused with fibrous dysplasia. The histopathological difference between the two lesions is described.

Adult↗

[Complications of nasal endoscopic surgery].

OBJECTIVE: To study the classification, incidence, mechanism and prevention of complications of nasal endoscopic surgery. METHODS: Sixty-two complications among 1,089 cases of nasal endoscopic surgery between February 1991 and October 1995 were analyzed. RESULTS: The types of complication included blindness (n = 1), retrobulbar hemorrhage (n = 1), inflammatory mass in orbit (n = 2), CSF (n = 2), nasolacrimal duct injury (n = 2), nasal septum perforation (n = 2), hemorrhage (n = 3), periorbital emphysema or ecchymosis (n = 14) and adhesion (n = 35). The total incidence was 5.7%, the incidence of major complications was 1.2% and minor complications 4.5%. CONCLUSION: The classification, estimation, mechanism and prevention of complications of nasal endoscopy were discussed, care should be taken to avoid the occurrence of complications and it is important to find and treat complications timely and accurately.

Adolescent↗

Nasolabial cyst: a retrospective analysis of 18 cases.

Nasolabial cysts are rare but easily identifiable when they do occur. They are thought to arise from the remnants of the nasolacrimal ducts, but most of the available information on these cysts is limited to isolated case reports. The purpose of our study was to examine the clinical and pathologic features of nasolabial cysts in order to provide a basis for their correct diagnosis and treatment. Eighteen patients with nasolabial cysts were treated at Korea University's Guro Hospital between Jan. 1, 1988, and Dec. 31, 1999. We retrospectively analyzed the clinical appearance, pathologic findings, and treatment results in each case. All patients underwent surgery via the sublabial approach. The lining epithelia were identified as either pseudostratified, stratified squamous, or simple cuboidal. A cyst recurred in only one case, and there were no surgical complications on follow-up. The results of our study provide a basis for sound diagnosis and treatment.

Adolescent↗

Recurring anterior facial swelling.

The nasolabial cyst was first reported in 1882. The most common clinical finding of the nasolabial cyst is that of an asymptomatic soft tissue swelling involving the canine fossa/nasal alar base region. The pathogenesis is controversial, but this cystic lesion most likely develops from the nasolacrimal duct. Microscopically, this cystic structure is composed of a fibrous capsule with an unremarkable layer of pseudostratified columnar epithelium. The treatment of choice is surgical excision, after which recurrence is rare.

Adult↗

NTP Toxicology and Carcinogenesis Studies of Nitromethane (CAS No. 75-52-5) in F344/N Rats and B6C3F1 Mice (Inhalation Studies).

Nitromethane is used as a rocket and engine fuel; as a synthesis intermediate for agricultural fumigants, biocides, and other products; as a solvent; and as an explosive in mining, oil-well drilling, and seismic exploration. It has been detected in air, in surface and drinking water, and in cigarette smoke. Nitromethane was studied because of the potential for widespread human exposure and because it is structurally related to the carcinogens 2-nitropropane and tetranitromethane. Male and female F344/N rats and B6C3F1 mice received nitromethane (purity 98% or greater) by inhalation for 16 days, 13 weeks, or 2 years. Genetic toxicology studies were conducted in Salmonella typhimurium, cultured Chinese hamster ovary cells, and peripheral blood erythrocytes of mice. 16-DAY STUDY IN RATS: Groups of five male and five female rats were exposed to 0, 94, 188, 375, 750, or 1,500 ppm nitromethane by inhalation, 6 hours per day, 5 days per week, for 16 days. All rats survived until the end of the study. The mean body weight gain of male rats in the 1,500 ppm group was slightly but significantly less than that of the controls; the final mean body weights and mean body weight gains of exposed females were similar to those of the controls. Clinical findings in all male and female rats in the 1,500 ppm groups included increased preening, rapid breathing, hyperactivity early in the study, and hypoactivity and loss of coordination in the hindlimbs near the end of the study. The relative liver weights of all exposed groups of male rats and the absolute and relative liver weights of females exposed to 375 ppm or greater were significantly greater than those of the controls. Minimal to mild degeneration of the olfactory epithelium was observed in the nose of males and females exposed to 375 ppm or greater. Sciatic nerve degeneration was present in all male and female rats exposed to 375 ppm or greater; rats exposed to 750 or 1,500 ppm also had reduced myelin around sciatic axons. 16-DAY STUDY IN MICE: Groups of five male and five female mice were exposed to 0, 94, 188, 375, 750, or 1,500 ppm nitromethane by inhalation, 6 hours per day, 5 days per week, for 16 days. All mice survived to the end of the study. The final mean body weights and weight gains of exposed males and females were similar to those of the controls. Clinical findings included hypoactivity and tachypnea in male and female mice in the 1,500 ppm groups. Absolute and relative liver weights of male mice in the 750 and 1,500 ppm groups and female mice in all exposed groups and the relative liver weight of males in the 375 ppm group were significantly greater than those of the controls. Degeneration of the olfactory epithelium of the nose was observed microscopically in all males and females exposed to 375 ppm or greater; this lesion was of minimal severity in males and minimal to mild severity in females. 13-WEEK STUDY IN RATS: Groups of 10 male and 10 female rats were exposed to 0, 94, 188, 375, 750, or 1,500 ppm nitromethane by inhalation, 6 hours per day, 5 days per week, for 13 weeks. All rats survived to the end of the study. The final mean body weight and weight gain of male rats in the 1,500 ppm group were significantly less than those of the controls. Clinical findings included hindlimb paralysis in rats in the 750 and 1,500 ppm groups. Inhalation exposure of rats to nitromethane resulted in an exposure concentration-dependent, microcytic, responsive anemia; anemia was most pronounced in males and females exposed to 375 ppm or greater. The presence of schistocytes, Heinz bodies, and spherocytes and increased mean cell hemoglobin concentration and methemoglobin concentration were evidence that a hemolytic process was occurring; this hemolytic process could have accounted, in part, for the anemia. Thrombocytosis accompanied the anemia and would be consistent with a reactive bone marrow or could have been due to the erroneous inclusion of small erythrocyte fragments as part of the platelet count. On day 23, transient decreases in serum triiodothyronine, thyroxine, and fr and free thyroxine were observed in male rats exposed to 375 ppm or greater and female rats exposed to 750 or 1,500 ppm. There was little or no pituitary response to the thyroid hormone decreases, as evidenced by the lack of significantly increased concentrations of thyroid-stimulating hormone in exposed rats. No biologically significant differences in organ weights were observed. The forelimb and hindlimb grip strengths of males in the 1,500 ppm group were significantly less than those of the controls. The hindlimb grip strengths of females in the 750 and 1,500 ppm groups were also significantly less than the control value. Minimal to mild hyperplasia of the bone marrow was observed microscopically in male rats in the 750 and 1,500 ppm groups and in females exposed to 188 ppm or greater. Nasal lesions in exposed males and females included olfactory epithelial degeneration in males and females exposed to 375 ppm or greater and in one female exposed to 188 ppm and respiratory epithelial hyaline droplets and goblet cell hyperplasia in males and females in the 750 and 1,500 ppm groups; the severity of nasal lesions in males and females was minimal to mild. Males and females exposed to 375 ppm or greater had minimal to mild degeneration of the sciatic nerve and the lumbar spinal cord. 13-WEEK STUDY IN MICE: Groups of 10 male and 10 female mice were exposed to 0, 94, 188, 375, 750, or 1,500 ppm nitromethane by inhalation, 6 hours per day, 5 days per week, for 13 weeks. All mice survived to the end of the study. The final mean body weights and weight gains of exposed mice were generally similar to those of the controls. There were no treatment-related clinical findings. The absolute right kidney weights of all groups of exposed male mice except the 1,500 ppm group and of females exposed to 188 ppm or greater and the relative right kidney weights of all groups of exposed males and of females in the 750 and 1,500 ppm groups were significantly greater than those of the controls. The absolute liver weight of male mice in the 750 ppm group and the relative liver weights of males exposed to 375 ppm or greater were significantly greater than those of the controls. Olfactory epithelial degeneration and respiratory epithelial hyaline droplets were observed microscopically in all male and female mice exposed to 375 ppm or greater. Degeneration also occurred in females in the 188 ppm group, and hyaline droplets occurred in females in the 94 and 188 ppm groups. The average severity of the nasal lesions ranged from minimal to mild in males. In females, the average severity of olfactory epithelial degeneration ranged from minimal to mild and the severity of respiratory epithelial hyaline droplets ranged from minimal to moderate. All males and nine females in the 1,500 ppm groups also had minimal extramedullary hematopoiesis of the spleen. 2-YEAR STUDY IN RATS: Groups of 50 male and 50 female rats were exposed to 0, 94, 188, or 375 ppm nitromethane by inhalation, 6 hours per day, 5 days per week, for 103 weeks. Survival,Body Weights, and Clinical Findings: There were no significant differences in survival rates between exposed and control male or female rats. The mean body weight of females in the 375 ppm group was slightly greater than that of the control group; the mean body weights of exposed males were generally similar to the mean body weight of the controls throughout the study. Clinical findings were consistent with incidences of mammary gland neoplasms in females exposed to 188 or 375 ppm; no hindlimb paralysis, as occurred in rats in the 13-week study, was observed in male or female rats in the 2-year study. Pathology Findings: The incidences of mammary gland fibroadenoma and fibroadenoma, adenoma, or carcinoma (combined) in female rats in the 188 and 375 ppm groups were significantly greater than those in the controls. Additionally, the incidences of mammary gland carcinoma in the 375 ppm group were significantly greater than those in the controls. 2-YEAR STUDY IN MICE: Groups of 50 male and 50 female mice were exposed to 0, 188, 375, or 750 ppm nitromethane by inhalation, 6 hours per day, 5 days per week, for 103 weeks. Survival,Body Weights, and ClinicalFindings The survival rate of females in the 750 ppm group was marginally greater than that of the controls. The mean body weights of exposed females were generally slightly greater than the mean body weights of the controls during the study but were generally similar to the mean body weight of the controls at the end of the study. The mean body weights of exposed males were similar to those of the controls throughout the study. Clinical findings included swelling around the eyes and exophthalmos in exposed males and females; these findings were coincident with harderian gland neoplasms. Pathology Findings: The incidences of harderian gland adenoma and adenoma or carcinoma (combined) in exposed mice increased with increasing exposure concentration and were significantly greater in males and females in the 375 and 750 ppm groups than those in the controls. The incidences of harderian gland carcinoma in males and females in the 375 and 750 ppm groups were also slightly greater than those in the controls. Female mice in the 188 and 750 ppm groups had significantly greater incidences of hepatocellular adenoma and hepatocellular adenoma or carcinoma (combined) than the controls. The incidences of liver eosinophilic focus increased with increasing exposure concentration, and the incidences in the 375 and 750 ppm groups were significantly greater than the control incidence. The incidences of alveolar/bronchiolar carcinoma in male mice in the 750 ppm group and female mice in the 375 ppm group were significantly greater than those in the controls. Females in the 750 ppm group also had a significantly greater incidence of alveolar/bronchiolar adenoma or carcinoma (combined) and a slightly greater incidence of alveolar/bronchiolar adenoma than the controls. Females in the 375 ppm group had a significantly greater incidence of cellular infiltration of histiocytes in the lung than the controls. The incidences of degeneration and metaplasia of the olfactory epithelium and hyaline degeneration of the respiratory epithelium were significantly greater in exposed male and female mice than those in the controls. Additionally, males in the 375 and 750 ppm groups had significantly greater incidences of inflammation of the nasolacrimal duct than did the controls. GENETIC TOXICOLOGY: Nitromethane was not mutagenic in any tests performed by the NTP. It did not induce mutations in Salmonella typhimurium, with or without S9 metabolic activation, and no induction of sister chromatid exchanges or chromosomal aberrations in cultured Chinese hamster ovary cells exposed to nitromethane was noted with or without S9. No increase in the frequency of micronucleated erythrocytes was observed in peripheral blood samples of male and female mice at the end of the 13-week inhalation study of nitromethane. CONCLUSIONS: Under the conditions of these 2-year inhalation studies, there was no evidence of carcinogenic activity of nitromethane in male F344/N rats exposed to 94, 188, or 375 ppm. There was clear evidence of carcinogenic activity of nitromethane in female F344/N rats based on increased incidences of mammary gland fibroadenomas and carcinomas. There was clear evidence of carcinogenic activity of nitromethane in male B6C3F1 mice based on increased incidences of harderian gland adenomas and carcinomas. There was clear evidence of carcin ogenic activity in female B6C3F1 mice, based on increased incidences of liver neoplasms (primarily adenomas) and harderian gland adenomas and carcinomas. Increased incidences of alveolar/bronchiolar adenomas and carcinomas in male and female mice exposed to nitromethane were also considered to be related to chemical administration. Exposure to nitromethane by inhalation for 2 years resulted in increased incidences of nasal lesions including degeneration and metaplasia of the olfactory epithelium and degeneration of the respiratory epithelium in male and female mice. Synonym: Nitrocarbol

Journal Article↗

[Idiopathic epiphoras in adults treated with lacrymal-nasal stents].

Fluoroscopic nonsurgical placement of an expandable polyurethane stent is less invasive than surgery for the treatment of epiphora due to obstruction of the nasolacrimal duct. It needs to be performed with the collaboration of an ophthalmologist, using a high resolution digital subtraction imaging unit.

Adult↗

Aggressive psammomatoid ossifying fibroma of the inferior turbinate and lateral nasal wall.

OBJECTIVE: Fibroosseous lesions are rare entities of the nose and paranasal sinuses, the terminology and classification of which are still confusing. Psammomatoid or aggressive (juvenile) ossifying fibroma is a benign messenchymal tumor usually met in the young age (5-15 years), in the sinonasal tract, bearing distinctive histomorphologic features and a tendency towards locally aggressive behaviour. METHODOLOGY: We report here a rare case of an aggressive psammomatoid ossifying fibroma of the inferior turbinate and the lateral nasal wall, with obstruction of the nasolacrimal duct, in a 68-year-old woman. RESULTS: Diagnosis was based on physical examination, CT scan imaging and histopathological examination. Treatment consisted of endoscopic intranasal resection of the tumor accompanied by removal of the lateral nasal wall. CONCLUSIONS: Fibro-osseous tumors of the nose and paranasal sinuses require aggressive surgical approach in order to avoid recurrence. Complete surgical excision may not always be possible mainly due to the tumor's extent and location.

Aged↗

NTP Toxicology and Carcinogenesis Studies of 1,2-Epoxybutane (CAS No. 106-88-7) in F344/N Rats and B6C3F1 Mice (Inhalation Studies).

1,2-Epoxybutane was selected for study because it is a short-chain epoxide that had been shown to be mutagenic and because no carcinogenicity data were available. Approximately 8 million pounds of 1,2-epoxybutane are produced annually in the United States. The chemical is used primarily as a stabilizer in chlorinated hydrocarbon solvents. Single-Exposure, Fourteen-Day, and Thirteen-Week Studies: Single-exposure, 14-day, 13-week, and 2-year studies were conducted in F344/N rats and B6C3F1 mice. The chemical was greater than 99% pure and was administered as a vapor by the inhalation route to mimic worker exposure; room air was used as the control exposure during these studies. Exposures were 6 hours per day (5 days per week), except in the single-exposure studies (4 hours). Additional studies were performed to evaluate the potential for genetic damage in bacteria and in mammalian cells. In the single-exposure studies, the chemical was administered at exposure concentrations of 400-6,550 ppm in rats and 400-2,050 ppm in mice. In the 14-day studies, rats and mice were exposed at 400-6,400 ppm, and in the 13-week studies, rats and mice were exposed at 50-800 ppm. All rats in the single-exposure studies at 6,550 ppm died; compound-related deaths were not seen in other dosed groups. All mice at 2,050 ppm and 4/5 mice of each sex at 1,420 ppm died; compound-related mortality was not seen in other dosed groups. In the 14-day studies, all rats at 3,200 and 6,400 ppm and 2/5 female rats at 1,600 ppm died; all mice at 1,600, 3,200, and 6,400 and 1/5 male mice at 800 ppm died. Final mean body weights of surviving rats exposed at 800 or 1,600 ppm were 12%-33% lower than those of the controls; final mean body weights of surviving mice at 800 ppm were 10%-12% lower than those of the controls. Compound-related lesions included pulmonary hemorrhage and rhinitis in rats at 1,600 ppm and nephrosis in mice at 800 and 1,600 ppm. In the 13-week studies, no compound-related mortality was observed in rats; all mice exposed at 800 ppm died. No compound-related clinical signs were seen in rats or in surviving mice. The final mean body weight of rats exposed at 800 ppm was 23% lower than that of controls for males and 16% lower for females. Final body weights of surviving mice were unaffected by exposure. Inflammation of the nasal turbinates was seen in rats at 800 ppm but not at lower exposure concentrations. Renal tubular necrosis was seen in mice at 800 ppm but not at lowerconcentrations. Inflammation of the nasal turbinates was observed in female mice at 100, 200, 400, and 800 ppm and in male mice at 200, 400, and 800 ppm. The highest exposure concentration selected for the 2-year studies in rats was 400 ppm because of body weight effects and nasal lesions observed at 800 ppm. The highest concentration selected for the 2-year studies in mice was 100 ppm because the nasal lesions seen at 200 and 400 ppm were considered to be potentially life threatening. Two-Year Studies: The 2-year toxicology and carcinogenesis studies of 1,2-epoxybutane were conducted by exposing groups of 50 animals per species and sex to the chemical by inhalation, 6 hours per day 5 days per week. Rats were exposed at concentrations of 0, 200, or 400 ppm for 103 weeks and mice at 0, 50, or 100 ppm for 102 weeks. Body Weight and Survival in the Two-Year Studies: The survival of all groups of dosed rats was at least 50% until week 98, but final survival was reduced in the dosed groups (final survival-- male: control, 30/50; low dose, 18/50; high dose, 23/50; female: 32/50; 21/50; 22/50). Mean body weights of control and exposed male rats were similar until week 86; thereafter, mean body weights of high dose male rats were 4%-8% lower than those of controls. Mean body weights of high dose female rats were 5%-10% lower than those of controls after week 22. Survival in male mice was comparable among groups (final survival: 41/50; 45/50; 33/50). Survival in female mice was greater than 50% in all groups at week 86 and then was reduced in high dose females toward the end of the stin all groups at week 86 and then was reduced in high dose females toward the end of the study (final survival: 29/50; 25/50; 9/50). This decreased survival was associated with suppurative inflammation of the ovary and uterus. Klebsiella oxytoca was isolated from these ovarian/uterine lesions. Mean body weights of high dose male mice were 10%-14% lower than those of the controls after week 69; mean body weights of low dose male mice were 4%-8% lower than those of the controls after week 86. Mean body weights of high dose female mice were 13%-23% lower than those of the controls after week 60, and mean body weights of low dose female mice were 12%-16% lower than those of the controls after week 73. Nonneoplastic and Neoplastic Effects in the Two-Year Studies: Dosed rats had nonneoplastic lesions of the nasal cavity including inflammation, epithelial hyperplasia, squamous metaplasia, hyperostosis of the nasal turbinate bone, and atrophy of the olfactory epithelium. Seven papillary adenomas of the nasal cavity were seen in highdose male rats and two in high dose female rats. The historical incidences of nasal cavity adenomas in untreated male and untreated female F344/N rats are less than 0.1%. The incidences of alveolar/bronchiolar carcinomas (0/50; 1/50; 4/49) and adenomas or carcinomas (combined) (0/50; 2/50; 5/49) were increased in high dose male rats; no increased incidences of these tumors were observed in dosed female rats. Dosed mice had increased incidences of nonneoplastic lesions of the nasal cavity but no significant increase in the incidence of neoplastic lesions of the nasal cavity. The nonneoplastic lesions included suppurative inflammation (empyema), epithelial hyperplasia, erosion, regeneration, and squamous metaplasia in the nasal cavity; atrophy of the olfactory sensory epithelium; hyperplasia of the nasal gland (Bowman's glands); and inflammation and hyperplasia of the nasolacrimal duct. A single squamous cell papilloma was seen in the incisive duct of one high dose male mouse. Genetic Toxicology: 1,2-Epoxybutane was mutagenic in Salmonella typhimurium strains TA100 and TA1535 when tested with a preincubational protocol with or without rat liver S9, indicating that it is a direct-acting mutagen capable of inducing base-pair substitutions in prokaryotes; it did not cause gene reversion in strains TA1537 or TA98. 1,2-Epoxybutane induced forward mutations at the TK locus of cultured mouse L5178Y lymphoma cells with and without metabolic activation. Both chromosomal aberrations andsister chromatid exchanges were induced in cultured Chinese hamster ovary cells after exposure to 1,2-epoxybutane in the presence and absence of metabolic activation. 1,2-Epoxybutane, when fed to male Drosophila, caused significant increases in the number of sex-linked recessive lethal mutations and reciprocal translocations in the germ cells. Data Audit: An audit of the experimental data was conducted for the 2-year studies of 1,2-epoxybutane. No data discrepancies were found that influenced the final interpretations. Conclusions: Under the conditions of these 2-year inhalation studies, there was clear evidence of carcinogenic activity of 1,2-epoxybutane for male F344/N rats, as shown by an increased incidence of papillary adenomas of the nasal cavity, alveolar/bronchiolar carcinomas, and alveolar/bronchiolar adenomas and carcinomas (combined). There was equivocal evidence of carcinogenic activity for female F344/N rats, as shown by the presence of papillary adenomas of the nasal cavity. There was no evidence of carcinogenic activity for male or female B6C3F1 mice exposed at 50 or 100 ppm. 1,2-Epoxybutane exposure was associated with adenomatous hyperplasia and inflammatory lesions of the nasal cavity in rats and inflammatory lesions of the nasal cavity in mice. Synonyms: 1-butene oxide; 1,2-butene oxide; butylene oxide; 1,2-butylene oxide; ethyl ethylene oxide; ethyl oxirane

Journal Article↗

[Surgical treatment with dacryocystitis and retinal detachment in a patient with Wegener granulomatosis].

BACKGROUND: We report surgical treatment of a patient with dacryocystitis and retinal detachment (RD), which are rare ophthalmic involvements of Wegener granulomatosis (WG). CASE: The patient was a 26-year-old man with WG. He was diagnosed as having WG 4 years ago and he has been treated by maintenance doses of predonisolone and cyclophosphamide. Rheumatoid factor and serum antinuclear antibody were negative. Cytoplasmic pattern-antineutrophil cytoplasmic antibody (C-ANCA) and renal function were normal. He was found to have nasolacrimal duct obstruction and lattice degeneration bilaterally, retinal tear with RD in the left eye and tear without RD in the right eye. No sign of vasculitis was found in fluorescein angiography. Bilateral dacryocystorhinostomy was performed without any sign of postoperative necrosis of the wound. After the surgery, epiphora and eye discharge disappeared and lacrimal passage has been maintained without obstruction. The pathological findings of his nasal mucosa and lacrimal sac showed chronic inflammation and no typical changes of WG. There was no abnormal change in the conjunctiva and sclera after an uncomplicated scleral buckling surgery. CONCLUSION: We conclude that operations such as dacryocystorhinostomy and scleral buckling surgery may be performed successfully when WG is controlled within the normal limits of C-ANCA.

Adult↗