A review of the environmental parameters necessary for an optimal sleep environment

Predictors of recurrence of urethral stricture disease following optical urethrotomy.

Background: To evaluate the effects of hyaluronic acid (HA) and carboxymethylcellulose (CMC) on the recurrence of urethral stricture after treatment with endoscopic internal urethrotomy (EIU). Methods: A total of 120 patients underwent EIU for urethral stricture. Recruited patients were randomly divided into two groups: group A and B. Patients in group A (60 patients, experimental group) received HA/CMC instillation and patients in group B (60 patients, control group) received lubricant instillation after internal urethrotomy. Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), and 24 weeks (V3) after the surgery. The effectiveness of HA/CMC instillation was evaluated based on the International Prostate Symptom Score/Quality of Life, peak urine flow rate, voided volume and postvoiding residual urine volume. The visual analogue scale (VAS) pain score and degree of satisfaction were also determined for each participant. Results: Among 120 initial participants, 53 patients in group A and 48 p...

The Effects of Hyaluronic Acid and Carboxymethylcellulose in Preventing Recurrence of Urethral Stricture After Endoscopic Internal Urethrotomy: A Multicenter, Randomized Controlled, Single-Blinded Study

To provide a comprehensive evidence-based assessment of the anatomical characteristics of the external branch of the superior laryngeal nerve (EBSLN). A thorough systematic search was performed on the major electronic databases PubMed, EMBASE, Cochrane library, and ScienceDirect to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcomes were the EBSLN identification rate (total number of EBSLN identified divided by the total number of dissected hemilarynges) and the prevalence of various EBSLN types. A total of 56 studies (n = 13,444 hemilarynges) were included. The overall pooled EBSLN identification rate was 89.24% (95% CI 85.49–92.49). This rate was higher for cadaveric (95.00%; 95% CI 89.73–99.35) compared to that reported in intraoperative studies (86.99%; 95% CI 82.37–91.01). Significantly higher identification rates were reported for studies in which intraoperative nerve monitoring was used (95.90%; 95% CI 94.30–97.25) compared to those which only relied on direct visual identification of the EBSLN (76.56%; 95% CI 69.34–83.08). Overall, Cernea type IIa (nerves crossing the superior thyroid artery less than 1 cm above the upper edge of the superior thyroid pole) and Friedman type 1 (nerves running their entire course superficial to the inferior pharyngeal constrictor) were the most prevalent (41.84%; 95% CI 33.28–48.08 and 50%; 95% CI 29.90–65.62, respectively). The combined prevalence of Cernea IIa and IIb (nerves crossing the superior thyroid artery below the upper edge of the superior thyroid pole) was higher in intraoperative studies compared to that in cadaveric studies (64.3% vs 49.4%). The EBSLN coursed medial to the superior thyroid artery in 70.98% (95% CI 55.14–84.68) of all cases. The use of intraoperative nerve monitoring improves EBSLN identification rates. In light of the highly variable anatomical patterns displayed by the EBSLN, thorough pre-operative knowledge of its anatomy can be crucial in minimizing incidences of its iatrogenic injury.

Surgical anatomy of the external branch of the superior laryngeal nerve: a systematic review and meta-analysis

Sleep thermal environment has a great effect on occupants’ sleep quality. The purpose of this study was to explore the relationships between sleep thermal environment parameters and sleep quality in winter and summer. The whole experiments involved indoor ambient temperatures (winter: 17 °C, 20 °C, 23 °C; summer: 23 °C, 26 °C, 29 °C) and relative humidity (RH; winter: 40%, 55%, 70%; summer: 40%, 60%, 80%). A total of 18 young subjects (23±2 years old) were divided into the two different season groups to experience the corresponding environmental conditions. Their subjective environmental perception and objective physiological signals were monitored. The results showed that thermal sensations at 20 °C in winter, as well as 26 °C in summer, were considered as the thermal neutral states. Humid sensation in winter before sleep was susceptible to SET*, while the middle value of SET* (32 °C) related to the middle indoor air temperature (26 °C) and air humidity (60%) before and after sleep could be the summer combination of neutral thermal environment. Furthermore, cold and wet environment in winter was found to seriously affect the deep sleep. In summer, mild temperature contributing to good sleep quality might weaken the effect of humidity on sleep. Through combining the sleep environmental perception result with contour line and regression analysis on objective sleep quality, the suggested values of thermal environment parameters for young adults (21–25 years old) were as follows: 20.3 °C and 56%RH in winter, as well as 26.1 °C and 52%RH in summer.

Parametric study on the sleep thermal environment

Objective: To evaluate the graft takes rate of the myringoplasties performed by underlay technique using temporalis fascia graft for the last one year and to assess the hearing improvement in the successfully operated cases. Methods: This prospective Study included 52 ears of 50 patients, who underwent myringoplasty. All operations were performed using an underlay technique and mostly by postaural approach. In all the cases, temporalis fascia was used for the reconstruction of TM . The data of all the patients regarding preoperative disease, perforation size and localization, surgical approach, graft material, pre- and postoperative clinical and functional (hearing evaluation by pure-tone audiogram) results were analyzed. Results: Successful closure rate of the TM perforation was 82.69% and the graft failure rate was 17.30%. In this study, lowest and highest age of patients at presentation was 12 and 42 years respectively with a mean age of 25.5 years. The success rate was better with the advancing age. The most common approach was postaural. Medium size and posterior perforations were common and the graft take rate was 80.95%, and 88.89% respectively. The mean pre and post-operative air conduction threshold in the successful cases were 38.69dB and 30.35 dB respectively with a mean audiological improvement of around 8 dB. The improvement in the hearing was achieved in only 67.44% (29 out of 43) among the successful operated myringoplasties. Conclusion: Myringoplasty is a safe and effective technique to improve the quality of life of patients. The most common approach was postaural. The graft takes rate was better with the advancing ages and with the medium size and posterior perforations. The improvement in hearing was also achieved. Journal of Nobel Medical College Vol. 2, No.1 Issue 3 Nov.-April 2013 Page 36-42 DOI: http://dx.doi.org/10.3126/jonmc.v2i1.7671

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Hearing Evaluation After Myringoplasty At Nepal Medical College And Teaching Hospital

Ear diseases are a common presentation in the ENT out-patient department. These diseases can have sequelae if not treated early which may cause increased morbidity, hearing disability and even mortality. Identifying these conditions early and treating them can reduce these unwanted sequelae. A prospective study over a period of three years was undertaken in a tertiary care hospital in Kathmandu. All children presenting with ear diseases consecutively in the ENT out-patients were included and their data was recorded in a pro forma. The data was analysed for frequency and cross-tabulated. The study included 2218 children with ear diseases among which 868 (39.1%) were pre-school and 1350 (60.9%) were school going children. The male to female ratio was 1.5:1. The most common otological problem was wax impaction (40.2%), followed by acute otitis media (AOM) with 24.3%, chronic suppurative otitis media (CSOM) with 17.7% and acute otitis externa (AOE) with 7.5% of the total cases. The other conditions were otitis media with effusion (2.8%), foreign bodies in the ear (2.3%), otomycosis (1.7%), preauricular sinus (1.1%), sensorineural hearing loss (0.8%), trauma to the ear (0.7%), keloids (0.3%), microtia (0.2%) and perichondritis (0.2%).The three year olds had the highest number of otological diseases with 9.2% of the total among the ages studied. It is felt that proper education of health care providers regarding ear diseases and also awareness in the community can prevent and reduce the disability and complications of these conditions.

Ear diseases in children presenting at Nepal Medical College Teaching Hospital.

Nepalese Journal of ENT Head and Neck Surgery Vol.2 No.2 Issue 2 (July-Dec 2011) 4-5 DOI: http://dx.doi.org/10.3126/njenthns.v2i2.6792

Epistaxis and its Relation with Temperature and Humidity

The study was conducted to find out if intermittent self dilatation (ISD) is still a viable option for treatment of urethral strictures in patients who had undergone either urethral dilatation or urethrotomy prior to ISD. The study included 310 male patients with the age range from 17 to 93 years old from January 1996 to March 2007. The data was gathered from the computer data base kept by the urology unit in the hospital. A questionnaire was used to evaluate their tolerance towards the procedure and quality of life. Of the total number of patients 262 replied to the questionnaire. The mean follow up was 57.68 months with 67.7% continuing with the procedure. The procedure was well tolerated by 84.1% of patients and 79.6% had no technical difficulty. The most number of patients carrying out this procedure were in the 6th and 7th decade of life. There was a recurrence rate of urethral strictures of 16.9%. It is seen that even today ISD following an endoscopic procedure is a viable treatment option. The patients seem to tolerate this procedure well and it is an option in the elderly patient group who may not be fit or willing to undergo reconstructive surgery or urethroplasty.

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Intermittent self dilatation--still a viable option for treatment of urethral stricture disease.

We report a rare case of intravascular papillary endothelial hyperplasia (IPEH) of the cheek. This neoplasm, known as Masson’s tumor, is an unusual vascular lesion of proliferating endothelial cells. It is usually confined to the lumen of preexisting vessels or vascular malformations. The principal significance of IPEH is its resemblance to a variety of benign and malignant diseases and possible misdiagnosis as such. Achieving a correct diagnosis is essential to avoid subjecting a patient to either unnecessarily aggressive or inadequate therapy. For this reason, awareness of this lesion is very important.

AS Rijal

Papers

Hearing Evaluation After Myringoplasty At Nepal Medical College And Teaching Hospital

Ear diseases in children presenting at Nepal Medical College Teaching Hospital.

Epistaxis and its Relation with Temperature and Humidity

Intermittent self dilatation--still a viable option for treatment of urethral stricture disease.

Masson’s Hemangioma of the Cheek: A Case Report