Citations

OBJECTIVE—Assessing clinimetric performance of diabetic sensorimotor polyneuropathy (DSPN) end points in single and multicenter trials. RESEARCH DESIGN AND METHODS—Assessed were placebo-treated patients with DSPN in the Viatris and Eli Lilly trials and an epidemiologic cohort. RESULTS—Test reproducibility in clinical trial cohorts (rI ∼ 0.7–0.85) approached that in the epidemiologic cohort (rI ∼ 0.85–0.95). Associations between pairs of end points explained <10% of the variability of data (sometimes 15–35%), being higher in the epidemiologic cohort and the Viatris trial than in the Lilly trial. Most end points did not show monotonic worsening over 4 years. However, sural nerve amplitude and peroneal motor conduction velocity did. A nerve conduction score (Σ 5 NC nds [5 attributes of nerve conduction expressed as normal deviates]) did not show monotonic worsening in established DSPN. In the epidemiologic cohort followed for 9.5 years, monotonic worsening of small magnitude occurred for sural amplitude, vibration detection threshold, and especially for composite quantitative sensation. CONCLUSIONS—The main reason why it is difficult to demonstrate monotonic worsening of neuropathic end points appears to be a very slow worsening of DSPN, a placebo effect for symptoms and signs, and measurement noise. Demonstrating disease progression in controlled trials of DSPN is more likely when 1) patients with developing rather than established DSPN are selected, 2) type 1 diabetic patients are preferentially recruited, 3) patients are selected who cannot or will not achieve ideal glycemic control, 4) end points chosen are known to show monotonic worsening, and 5) a restricted number of centers and expert examiners (trained, certified, using standard approaches, and reference values and interactive surveillance of tests) are used.

Hemangiopericytomas are rare tumors of vascular origin most commonly found in the extremities or retroperitoneal area. When they originate from the nasal cavity and paranasal sinuses, they tend to be less aggressive and generally do not metastasize. The term “hemangiopericytoma-like lesion” has been coined for sinonasal hemangiopericytomas that display more benign histologic and growth characteristics than do those located elsewhere. Fifteen cases of hemangiopericytoma of the nasal cavity and paranasal sinuses were reviewed over the period 1951 to 1990; included are follow-up data on cases reported earlier from this institution. The clinical course, management, and outcome was evaluated and correlated with the histologic characteristics of the tumors. The recurrence rate in our series was 13.3%; the mean follow-up was 11 years. No patients died of their disease or had evidence of metastatic disease. This clinicopathologic review suggests that sinonasal hemangiopericytomas should not be classified as “hemangiopericytoma-like” lesions; rather, they should be expected to have significant local recurrence rates with low rates of distant metastasis and mortality. Long-term follow-up is essential as there can be local recurrence after many years.

Experimental rhinovirus infection in volunteers has provided important new knowledge on the pathogenesis and treatment of rhinovirus colds. However, the clinical parameters of this illness have not been well defined. In the current study, data on 151 young adult subjects in 14 previous studies were used to determine representative values for nasal mucus weights and total and nasal symptom scores for the rhinovirus challenge model. The mean ± SD total mucus weight for 5 days was 22.6 g ± 22.2 and the mean total symptom score was 16.4 ± 12.7. By univariate analysis, the 5-day total mucus weight correlated with the 5-day score for rhinorrhea, nasal obstruction, and total symptoms, but by multivariate analysis the correlation was primarily with rhinorrhea. Similar findings were seen using daily mean values. The information obtained from this analysis will be useful in planning and interpreting the results of future experiments using the rhinovirus model.

Intranasal sphenoethmoidectomy is one of the most frequently performed operations in otorhinolaryngology. Surgical indications and techniques have evolved with advances in medical technology. Clinical reports describing complications relating to sphenoethmoidectomy, either by traditional or endoscopic technique, have elucidated the potentially dangerous nature of this procedure. 1–6 Intraoperative complications are avoided through a detailed knowledge of anatomy and a technique guided by structural landmarks. We present a case of sphenoethmoidectomy complicated by cerebrospinal fluid (CSF) rhinorrhea and a nasal encephalocele.

Nasal obstruction and recurrent sinusitis are among the most common problems encountered by rhinologists in daily practice. Unfortunately, the occurrence of primary ciliary dyskinesia and the symptoms common to this entity often lead to months or years of delayed diagnosis. Many testing methods have been used including phase contrast and electron microscopy although consensus on diagnosis and treatment has not been established. Described in this report is a male adolescent with this disorder and a new method of ciliary testing we have developed to aid in diagnosis.