Academic literature on the topic 'Nasal endoscopy single-dose instillation'

<strong>The aim.</strong>&nbsp;To substantiate the safety using of the new nasal spray with Enisamium Iodide via study results of acute local drug-induced irritant action of the test object single-dose to eyes and nasal cavity mucosa. <strong>Material and methods.</strong>&nbsp;Enisamium Iodide 10 mg/mL (nasal spray) was the test object. The reference drug was 0.9 % saline. Flemish Giant rabbits were used to induce the experiment (2 groups, 9 rabbits in each group). All study objects were administered in single-dose into the eye conjunctival sacs (0.01 mL) and nasal passages (0.1 mL) by instillation. The eye examination we performed in different time observation point (through 1, 24, 48 and 72 h after drug instillation). Nasal endoscopy was used for control of nasal cavity in all stages of study (15 minutes before, 1-hour and 24 hours after drug instillation) under general anesthesia. The scales of the assessment were used to the result objectivity. <strong>Results.</strong>&nbsp;The total score was 0 points in all groups at all-time points according to the relevant scale and the scale of the assessment of rabbit nasal cavity mucosa by nasal endoscopy results. This corresponds to the condition of a healthy eye and healthy nasal mucosa. <strong>Conclusions.&nbsp;</strong>Enisamium Iodide 10 mg/mL (nasal spray) in the single-dose instillation into the rabbit eye conjunctival sacs and rabbit nasal passages did not show local drug-induced irritant action on the eye conjunctiva and nasal cavity mucosa in the experimental animals. Nasal endoscopy could be used as an informative visual method in preclinical studies

Despite its metabolic complications, systemic corticosteroid therapy remains a mainstay in the treatment of refractory polyposis after endoscopic frontal sinusotomy. Furthermore, topical nasal corticosteroids often fail, presumably due to the relatively small dosage actually absorbed by the polyps. In order to minimize steroid complications while increasing the locally absorbed dose, beclomethasone (approximately 1 cc, 84 mcg/100 μl) was instilled under endoscopic guidance directly into the frontal sinus in 31 instances in 16 patients with postoperative frontal recess/sinus polyposis and mucosal edema. The frontal recess/sinus polyposis/edema resolved completely in 9 frontal sinuses, improved considerably in 7 frontal sinuses, improved minimally in 5 frontal sinuses, and remained unchanged in 10 frontal sinuses. No complications were noted. AM cortisol levels remained in the normal range. Endoscopically guided frontal sinus beclomethasone instillation should be considered for the treatment of refractory postoperative frontal sinus/recess polyposis/edema. Further basic and clinical research into the pathophysiology of the nasal mucosa is also warranted.

Background: The aim of this prospective study is to evaluate whether changes in endoscopy score correlate with changes in quality of life (QOL) in nasal polyposis (NP) patients after optimal medical therapy. Methodology: An interventional clinical trial study involving fifty five patients with grade I and II NP was conducted. Patients were initially treated with a single dose oral prednisolone 25 mg for 2 weeks, Macrolide 250 mg daily for the first 3 months and long-term intranasal steroids. All patients were followed up and evaluated subjectively by Rhinosinusitis Disability Index question- naire and objectively by endonasal endoscopy between December 2011 to October 2013. Results: At baseline, patients showed significantly bad QOL scores on all domains. At 3 months, a significant improvement in all impaired QOL domains and reduction of the nasal polyp size were demonstrated compared to baseline. At 6 and 12 months, no significant improvement between QOL scores and nasal polyp size was observed. Conclusion: Optimal medical treatments improve both the QOL and nasal polyp size in grade I and II NP patients. However, the changes in endoscopy scores explain a part of the improvement in QOL outcomes as the latter are multidimensional constructs.

ABSTRACTBacillus anthracisis the causative agent of anthrax, and its spores have been developed into lethal bioweapons. To mitigate an onslaught from airborne anthrax spores that are maliciously disseminated, it is of paramount importance to develop a rapid-response anthrax vaccine that can be mass administered by nonmedical personnel during a crisis. We report here that intranasal instillation of a nonreplicating adenovirus vector encodingB. anthracisprotective antigen could confer rapid and sustained protection against inhalation anthrax in mice in a single-dose regimen in the presence of preexisting adenovirus immunity. The potency of the vaccine was greatly enhanced when codons of the antigen gene were optimized to match the tRNA pool found in human cells. In addition, an adenovirus vector encoding lethal factor can confer partial protection against inhalation anthrax and might be coadministered with a protective antigen-based vaccine.

Background: External beauty of human being is mainly dependent upon the quality of skin. Melasma is common hyperpigmentation disorder in the facial skin of the Indian women. It is the cause of common socio-cosmetic stigma along with hindrance to the success of more or less all professions. Allopathic management of melasma is having higher recurrence rate with mild to moderate adverse effect. This case study is to establish a scientific data to the Ayurvedic cosmetology in the management of melasma. Case summary: A 25 year old female, known case of melasma since last 5 years attended OPD of Panchakarma dept. Rishikul campus. After assessing the nidan and samprapti, she was planned for nasya with kumkumadi tailam along with some herbomineral compound. Allopathic medication which she had been taking for the same problem was reduced in tapering dose and after 1 week she was completely on Ayurvedic management. During the total study period (56 days) the patient was assessed for five times. Patient had shown significant improvement in symptoms like darkness, area involvement, itching, swelling, dryness related to the patches. Subjective and Objective parameters of the study is observed and assessed with the criteria as per the modern cosmetology. Conclusion: Ayurveda, in the field of cosmetology is a promising aspect of practice. This single case study has shown highly significant result with combined management of Ayurvedic internal medication with panchakarma therapy. It surely can lead to find out solution of different problems in the field of cosmetology with Ayurvedic/panchakarma treatment.

Macrocyclic trichothecene mycotoxins encountered in water-damaged buildings have been suggested to contribute to illnesses of the upper respiratory tract. Here, the authors characterized the adverse effects of repeated exposures to roridin A (RA), a representative macrocyclic trichothecene, on the nasal airways of mice and assessed the persistence of these effects. Young, adult, female C57BL/6 mice were exposed to single daily, intranasal, instillations of RA (0.4, 2, 10, or 50 μg/kg body weight [bw]) in saline (50 μl) or saline alone (controls) over 3 weeks or 250 μg/kg RA over 2 weeks. Histopathologic, immunohistochemical, and morphometric analyses of nasal airways conducted 24 hr after the last instillation revealed that the lowest-effect level was 10 μg/kg bw. RA exposure induced a dose-dependent, neutrophilic rhinitis with mucus hypersecretion, atrophy and exfoliation of nasal transitional and respiratory epithelium, olfactory epithelial atrophy and loss of olfactory sensory neurons (OSNs). In a second study, the persistence of lesions in mice instilled with 250 μg/kg bw RA was assessed. Nasal inflammation and excess luminal mucus were resolved after 3 weeks, but OSN loss was still evident in olfactory epithelium (OE). These results suggest that nasal inflammation, mucus hypersecretion, and olfactory neurotoxicity could be important adverse health effects associated with short-term, repeated, airborne exposures to macrocyclic trichothecenes.

A technically easy, noninvasive means of delivering molecules to alveoli, which act selectively or specifically in the lung, would be experimentally and therapeutically useful. As proof of principle, we took advantage of the spreading ability of pulmonary surface active material (InfaSurf), mixed it with elastase, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) small inhibitory RNA (siRNA), or all- trans retinoic acid (ATRA), and instilled microliter amounts of the mixture into the nose of lightly anesthetized mice. One instillation of elastase caused diffuse alveolar destruction (emphysema) demonstrating widespread alveolar delivery. A single nasal instillation of GAPDH siRNA, compared with scrambled GAPDH siRNA, lowered GAPDH protein in lung, heart, and kidney by ∼50–70% 1 and 7 days later. To test the possibility of lung-specific delivery of a potentially therapeutic drug, we administered ATRA and monitored its effect on expression of cellular retinol binding protein (CRBP)-1 mRNA, whose translation product is a key molecule in retinoid metabolism. Given intranasally, ATRA elevated CRBP-1 mRNA 4.3-fold in a lung-specific manner. The same dose and dose schedule of ATRA given intraperitoneally increased CRBP-1 mRNA only ∼1.8-fold in lung; intraperitoneally administered ATRA elevated expression of CRBP-1 mRNA 1.7-fold or more in brain cortex, cerebellum, and testes, thereby increasing the risk of untoward effects. This simple noninvasive technique allows regulation of specific proteins in the lung and lung-specific delivery of reagents of experimental and potentially therapeutic importance.

Summary Vaccination of cattle with a tissue culture-derived Pasteurella haemolytica serotype 1 vaccine elicited a serotype-specific inhibition of nasal and tonsillar colonization by the homologous serotype under field conditions. Calves (n = 101) originated from a single farm, where half the calves were vaccinated. The calves were delivered to an order-buyer barn 105 days later, and given a second dose of vaccine. At the order-buyer barn, calves were mixed with 27 calves, some of which had clinical signs consistent with respiratory tract disease. Also 12 of the original calves were infected with P haemolytica serotype 1 by tonsillar instillation. After 6 days at the order-buyer barn, calves were shipped 1,600 km by truck to a feedyard, and arrived the next day. Tonsillar wash and nasal secretion aspiration specimens were collected for culture of P haemolytica on days 1, 8, and 29 at the feedyard. Inhibition of colonization was evidenced by lower frequency of isolations from the vaccinates than from the nonvaccinates after transport to the feedyard. Selectively lowering the frequency of colonization by P haemolytica serotype 1 could reduce losses attributable to pneumonic pasteurellosis.

Laryngeal web is a rare entity, constituting 5% of all congenital laryngeal lesions, with a reported incidence of 1 in 10,000.1 It usually presents with stridor in childhood, but can be discovered in asymptomatic adults under anesthesia and is associated with failed intubations.2 We present the case of a newborn with stridor and respiratory distress due to laryngeal web.&#x0D; &#x0D; CASE REPORT&#x0D; &#x0D; A 47-day-old boy was referred to our institution for stridor. He was spontaneously born term at 40 3/7 weeks gestational age to a 26-year-old G2P2 (2002). Birth weight was 3104 grams and maturity testing at 39 weeks was appropriate for gestational age. Prenatal and perinatal history was unremarkable. &#x0D; &#x0D; Upon delivery with an initial Apgar score of 5 becoming 6, inspiratory stridor and impending respiratory failure prompted intubation. Post-intubation chest x-ray revealed minimal lung disease and the baby was extubated after 24 hours. Six hours after extubation, stridor was noted again and the baby was reintubated. A chest x-ray showed atelectasis and the baby was managed as a case of pulmonary hypertension. He was weaned from ventilatory support and continuous positive airway pressure (CPAP) was commenced on day 15. Lavage feeding was started on day 18 and 7-day empiric antibiotics were completed. However, stridor and respiratory distress persisted, and the baby was reintubated and recommitted to a mechanical ventilator. Laryngomalacia was suspected, a tracheostomy was recommended and the baby was referred to our institution for further work-up and management. Our admitting impression was a term baby boy with pneumonia, and laryngomalacia versus tracheomalacia.&#x0D; &#x0D; Upon arrival at our institution, chest x-ray showed hazy and reticular opacities at the posterobasal segment of both lower lung lobes, more on the right, and interpreted as bilateral pneumonia. Ampicillin and Cefotaxime were started, and gram stain, culture and sensitivity of endotracheal secretions resulted in moderate growth of S. marscescens and light growth of K. pneumonia, both resistant to Ampicillin. Antibiotics were shifted to Gentamycin and Ceftazidime, given for 10 days.&#x0D; &#x0D; During this time, the baby was also exhibiting myoclonic upper extremity movements but was subsequently cleared for seizures or other structural brain pathology by Neurology. Our plan for airway evaluation was initial flexible endoscopy followed by bronchoscopy if extubation was tolerated. The possibility of a tracheostomy was considered if extubation would not be tolerated.&#x0D; &#x0D; Flexible endoscopy revealed patent nasal airways with no demonstrable nasal obstruction or structural abnormalities. The endotracheal and orogastric tubes were visualized entering the trachea and esophagus respectively. (Figure 1) There was pooling of secretions in the hypopharyngeal area, but no visible masses or lesions. &#x0D; After extubation, a soft tissue band was visualized traversing the right and left true vocal cords posteriorly, consistent with an interarytenoid web. (Figure 2) A space between this band and the interarytenoid area corresponded to the site where the ET tube had passed. The arytenoid mucosa also appeared swollen and edematous. The epiglottis was normal. There was vocal fold motion with incomplete glottic closure, but the full extent of glottic opening and closing could not be assessed due to the band. Because of decreasing oxygenation and episodes of desaturation, the baby was reintubated and a tracheostomy was performed.&#x0D; The baby was weaned off the ventilator a week later, and transferred out of intensive care to a regular room where he tolerated room air. Clotrimazole that had been given for light growth of S. maltophilia obtained intraoperatively was shifted to Levofloxacin and the last dose was given after 7 days. His postoperative course was unremarkable, and he was discharged with a tracheostomy and nasogastric tube, with suck and swallow therapy for eventual oral feeding. Regular monitoring and routine tracheotomy care with periodic tube changes and endoscopic surveillance of the web and signs of reflux are scheduled.&#x0D; &#x0D; DISCUSSION&#x0D; &#x0D; The most likely conditions for stridor presenting at birth are congenital structural anomalies like laryngomalacia (60%), vocal cord paralysis (15-20%), congenital subglottic stenosis (15%), laryngeal web (5%), or subglottic hematoma (1.5%).1,2,3&#x0D; &#x0D; The larynx develops from the endodermal lining and the adjacent mesenchyme of the foregut between the fourth and sixth branchial arches. The arytenoid swelling is formed at the cranial end of the laryngotracheal tube by the proliferation of the mesenchymal tissue (derived from neural crest cells). It grows towards the tongue and forms the primordial glottis. As it grows further, it changes the primordial glottis into a T-shaped laryngeal inlet.4&#x0D; &#x0D; Congenital laryngeal webs are uncommon, constituting 5% of all congenital laryngeal lesions; their incidence has been estimated at approximately 1 in 10,000 births.4 They are due to incomplete recanalization of the laryngotracheal tube during the third month of gestation, leading to different degrees of laryngeal webs. The most common site of development is at the level of the vocal folds anteriorly, although they may occur in the posterior interarytenoid or in the subglottic or supraglottic area.5 Diagnosis may be made via flexible or rigid laryngoscopy, or airway films if subglottic or cricoid pathology is present.4&#x0D; &#x0D; Most congenital webs present at birth or in the first few months of life. Symptoms range from mild dysphonia to significant airway obstruction, depending on the size of the web. Hoarseness, croup, and dysphagia are some other symptoms. A third of children with laryngeal webs have anomalies of the respiratory tract, most commonly subglottic stenosis. When congenital in origin, this may be associated with various syndromes like Di-George syndrome, velocardiofacial (Shprintzen) syndrome, conotruncal anomaly face syndrome.6,7&#x0D; &#x0D; Laryngeal webs may be classified according to airway obstruction. A T1 web is uniform in thickness with no subglottic extension, has true vocal cords clearly visible in the web, usually has no airway obstruction, and hoarseness as the only usual presenting sign. A T2 web is slightly thicker, with a significantly thicker anterior component, and may have minimal subglottic involvement, and a usually husky voice. A T3 web is thick with a solid anterior portion that extends into the subglottis, the true vocal cords are not well delineated, and there is marked vocal dysfunction, with a weak and whispery voice. A T4 web is uniformly thick and extends into the subglottic area with resulting subglottic stenosis. Respiratory obstruction is severe, and the patient is almost always aphonic.4,7 Webs may also be classified according to location, whether anterior, posterior (interarytenoid), subglottic, or supraglottc.4 Our patient had a type 1, interarytenoid laryngeal web.&#x0D; &#x0D; About 75-90% of laryngeal webs are located anteriorly and extend toward the arytenoids. Occasionally, a minor web will not be diagnosed until the child is older and undergoes evaluation for chronic hoarseness.1 It may vary in thickness, and the boundary is the vocal process.5 Posterior webs may present with apparent bilateral vocal cord paralysis, especially if an interarytenoid web in the posterior larynx limits vocal fold abduction. This type of congenital web is rare and often necessitates a tracheotomy in the early years of life. Stridor is the major presenting clinical feature (as in our case), but patients can also present with obstructive cyanosis at birth or episodes of apnea.2&#x0D; &#x0D; Asymptomatic patients do not require treatment. Treatment depends on the severity of airway obstruction, and may be single or multi-staged. If a patient presents with difficulty breathing, the airway must first be secured. This can be done through endotracheal intubation, which can be converted into a tracheostomy if prolonged intubation is expected.6 Long-term tracheotomy with observation for eventual decannulation after 3 to 5 years may be practiced. Surgical division can be achieved using laryngeal knives, microscissors, galvanocautery or radiofrequency. However, these are frequently unsuccessful as vocal cords re-adhere in the area where the web was separated.4,8 Surgical correction results in two opposing surfaces with denuded epithelium that tend to heal together and reform a web. To prevent re-adhesion, a keel, stent or probe may be positioned between the two raw edges. Steroid injections or mitomycin may also diminish re-adhesion.2 Extensive webs often require arytenoidectomy or even open laryngeal reconstruction to correct subglottic stenosis. This can be done with a costal graft, a posterior cricoid split, or a T-tube.9&#x0D; &#x0D; Given that our patient has a type 1 laryngeal web with a thin band, some may suggest that we observe the patient for 3-5 years in the hope that it might be outgrown.3 Others would divide or excise the web.3,4 However, the course of healing in our pediatric patient may be different compared to adults. If we perform outright division, there could be a higher risk of re-adhesion. Moreover, the presence of reflux (swollen arytenoids) may hasten the recurrence of the web or contribute to development of another laryngeal pathology like laryngomalacia.3&#x0D; &#x0D; We are not aware of any definite treatment protocol that applies to our patient. As such, our current plan is serial monitoring to determine when he will be a good candidate for surgery. At the very least, we want to see a resolution of signs of reflux that may increase the risk of recurrence post surgery. We have yet to determine our final plan for surgical intervention and the optimal timing for it, and are open to receiving your comments.&#x0D;

TPS4629 Background: Upper tract urothelial carcinoma (UTUC) constitutes 5–10% of primary urothelial carcinomas, affecting two in 100,000 people in the US annually. Peak incidence occurs in patients 70–90 years of age. 1-3 Low-Grade (LG) UTUC represents 40% of the total disease burden. 3 Endoscopically-guided ablation is often used to treat LG-UTUC, however recurrence is common, and the long-term surveillance risks potential complications in this elderly patient population. UGN-101 is a reverse thermal hydrogel formulation of mitomycin approved for chemoablative treatment of LG-UTUC, administered as a liquid in a chilled state, which converts to a gel depot at body temperature, resulting in a dwell time of 4–6 hours. In the phase 3 OLYMPUS trial, 42 of the 71 LG-UTUC patients treated with UGN-101 achieved complete response (CR) at 3 months. 4 Among the 41 patients followed after CR, median follow-up was 28.1 months (95% CI, 13.1-57.5), and median duration of response (DoR) was 47.8 months (95% CI, 13.0-not estimable). 5 Methods: The uTRACT registry (NCT05874921) is evaluating real-world data from patients administered UGN-101, post-FDA approval(15 Apr 2020) . Approximately 400 patients &gt;18 years old with UTUC who received ≥1 dose of UGN-101 will be enrolled at ∼20 sites. Retrospective data will be collected from patients that received UGN-101 after approval as well as prospective data from newly eligible patients. UGN-101 is administered as 6 once weekly pyelocalyceal instillations retrograde via ureteral catheter or antegrade via a nephrostomy tube. Instillation volume is based on volumetric measurements, not to exceed 15 mL (60 mg of mitomycin). For participants with a CR 3 months after the first dose, once monthly maintenance instillations may be administered ( up to 11 additional doses). Participant history and disease status are collected at baseline (prior to UGN-101 dosing), and dosing information, surveillance endoscopy and imaging results will be captured over a period of 3 years post baseline, at approximately 3, 6, 12, 24, and 36 months after the first instillation. Assessment of response will be based on endoscopic surveillance, imaging, cytology, and/or for-cause biopsy. Data analysis will be performed on the overall cohort (∼400 participants) and the LG-UTUC cohort (expected to be ∼340 participants). Outcomes collected include no evidence of disease at 3-months, DoR, recurrence free survival, time to recurrence/progression and adverse events. The uTRACT registry started enrollment in 2023 with 228 patients recruited to date. 1. Siegel RL, et al. CA Cancer J Clin. 2022;72:7-33. 2. Rouprêt M, et al. Eur Urol. 2023;84:49-64. 3. Raman J, Shore ND. Rev Urol. 2020;22:1-8. 4. Kleinmann N, et al. Lancet Oncol. 2020;21:776-785. 5. Pierorazio PM, et al. J Urol. 2024:101097ju0000000000004331. Clinical trial information: NCT05874921 .