Severity of injury from caustic ingestion damages depend on the type of ingested substance, which varies depending on ethnicity. Ingestion of caustic agents by children involves specific substances according to the season, cultural and religious festivals, and ethnicity. The majority of adult cases are intentional with more serious injuries and a higher rate of complications. In our series, ingestion of acidic substances and ingestion associated with suicide attempt had the most severe consequences.

Most ESS procedures can be managed without packing or any other hemostatic measures. Local anesthesia, use of local vasoconstrictors, and careful operative technique minimize the need for nose packing, thus reducing patient's discomfort, postoperative complications, and cost of surgery.

Early detection of IA in BMT patients enables aggressive treatment before the disease spreads into the orbit or brain. Proper preoperative preparation facilitates safe endoscopic surgery in patients with severe bleeding tendencies. Although sinonasal IA is lethal, endoscopic surgery is feasible and efficient, enabling excellent local control.

ITAMAR RAZ, MD 1OBJECTIVE -To evaluate the pharmacodynamic and pharmacokinetic properties and the dose-ranging effects of an oral insulin spray in comparison with subcutaneous regular insulin.RESEARCH DESIGN AND METHODS -In this randomized, five-way, cross-over study, seven healthy volunteers were assessed under euglycemic clamp and received four different doses of oral spray and one dose of subcutaneous regular insulin.RESULTS -The time to maximum insulin concentration was shorter for oral insulin than for subcutaneous insulin (25.9 Ϯ 9 vs. 145.7 Ϯ 49.5 min, P Ͻ 0.05). Maximum serum insulin levels (C max ) were comparable between the subcutaneous and 20 puffs of oral insulin (39.1 Ϯ 19.6 vs. 34.0 Ϯ 7.4 U/ml, NS). The Ins-AUC 0 -120 (area under the curve from 0 to 120 min for serum insulin) (339.8 Ϯ 218, 681.3 Ϯ 407, and 1,586.7 Ϯ 8 U/ml, P Ͻ 0.05) and C max (7.6 Ϯ 2.8, 16.4 Ϯ 9.3, and 39.1 Ϯ 19.6 U/ml, P Ͻ 0.005) proved a dose-response relationship for the three doses of oral insulin (5, 10, and 20 puffs, respectively). Oral insulin had an earlier onset of action (31.7 Ϯ 12 vs. 77.8 Ϯ 3 min, P Ͻ 0.05), earlier peak (44.2 Ϯ 10 vs. 159.2 Ϯ 68 min, P Ͻ 0.05), and a shorter duration of action (85.1 Ϯ 25 vs. 319.2 Ϯ 45 min, P Ͻ 0.05) compared with subcutaneous insulin. The maximum metabolic effect (1.7 Ϯ 1.0, 3.09 Ϯ 1.7, and 4.6 Ϯ 1.5 mg ⅐ kg Ϫ1 ⅐ min Ϫ1 , P Ͻ 0.05) and the GIR-AUC 0 -120 (amount of glucose infused from 0 to 120 min) (106.7 Ϯ 74.3, 162.9 Ϯ 116.1, and 254 Ϯ 123 mg/kg) increased in a dose-dependent relationship for the three doses.CONCLUSIONS -Oral insulin was absorbed in direct relation to the amount given and had a faster onset and a shorter duration of action compared with subcutaneous regular insulin. A dose-response relationship in the absorption and metabolic effect of the oral insulin was noted. Diabetes Care 28:1353-1357, 2005I nsulin therapy is central to the treatment of people with type 1 (and some with type 2) diabetes. Intensive insulin regimen is proven to be associated with better long-term clinical outcomes; however, the inconvenience of multiple daily insulin injections might reduce compliance and possibly constitute an obstacle to obtaining good glycemic control.Therefore, alternative, noninjectable ways of insulin administration are being researched. One of these is oral insulin administration delivered by a spray device into the oropharyngeal cavity. It has the potential to more closely resemble the meal-stimulated physiologic insulin profile and therefore to become an attractive option and easy-to-use route for covering prandial insulin requirements. We used an oral insulin spray system that consists of an insulin formulation containing human recombinant insulin (Humulin R), a surfactant, a solubilizer, a micelle-creating agent, and emulsifying agents. All excipients are found on the FDA Generally Recognized as Safe list. The Generex RapidMist device, which is a proprietary pressurized Metered Dose Inhaler used to administer small-and largemolecule drugs to the buccal mucosa was u...

Osteomas are benign, slow growing tumors of bone that occur almost exclusively in the craniofacial region. They are uncommon in the temporal bone. Surgical excision is indicated in symptomatic cases. An osteoma arising from the lateral semicircular canal growing into the mastoid cavity is extremely rare and usually discovered on routine radiography. We present a case of osteoma arising from the lateral semicircular canal growing into the mastoid cavity, followed by a discussion of the etiology, presentation, and management of osteomas.