Frozen sections of cholesteatomas were compared with postauricular and auditory canal skin and studied using histochemical methods. Several dehydrogenases, lysosomal enzymes and proteolytic activity were studied. Lactate and malate dehydrogenase activity was very strong in the epithelium and subepithelial tissue of cholesteatomas; no succinate dehydrogenase activity was observed. Esterase and acid phosphatase activity was prominent in cells of granulation tissue. Considerable proteolytic activity was observed in these cells and one specimen showed possible extracellular activity. Strong evidence of fat was found in the granulation tissue, particularly at the interface of granulation tissue and bone. In postauricular and auditory canal skin, enzyme activity was generally weaker; no evidence of fat was found. The findings are discussed in the light of other investigations on the importance of enzyme activity in bone destruction associated with cholesteatoma.

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Objective: 1) To understand the current evidence between the effects of pregnancy, postpartum, menopause, contraception, and hormone replacement therapy (HRT) on diseases of the nose. 2) To appraise the level of evidence in the current literature.Method: Systematic search strategy using PubMed (1966-2011) and EMBASE (1980-2011 was done to study diseases of the nose in women during different stages of life. Study appraisal and data extraction were performed independently by 2 authors. The level of evidence was categorized according to the Oxford Center of Evidence-Based Medicine.Results: Titles and abstracts of 1005 studies from PubMed and 1756 studies from EMBASE were reviewed, resulting in 429 being retrieved. Included articles were categorized as related to pregnancy, postpartum, menopause, contraception, or hormone replacement therapy with the following findings: Pregnancy: changes reported in olfaction (12 studies), allergy (30 studies), rhinitis (25 studies), epistaxis (8 studies), tumor growth (31 studies), Wegener's (23 studies), and Churg-Strauss disease (8 studies); Postpartum: effects included allergic rhinitis (20 studies), altered olfaction (7 studies), choanal atresia with drug ingestion (5 studies), and nasal tumors (8 studies); Menstruation: alteration in olfaction (17 studies), rhinitis (7 studies), and allergy (3 studies); Menopause: rhinitis (5 studies); HRT: alteration in olfaction (3 studies), and rhinitis (11 studies); and Estrogen therapy: considered for recurrent epistaxis (15 studies). Conclusion:The various stages of life in women have been shown to have impact on nasal pathophysiology, altering olfaction and increasing epistaxis, allergic symptoms, tumor growth, and auto-immune disease. Rhinology/Allergy Temporary Sphenopalatine Artery Occlusion: A Cadaver Study Patrick J. Fitzgerald, MD (presenter)Objective: To assess the ability of a surgical device (SinuStat, Sinocclusive LLC) to temporarily occlude flow in the sphenopalatine artery in the human cadaver model. Method:The experiment was performed on January 28, 2012, in the setting of a fully accredited ambulatory surgical suite. A human cadaver model simulating hydraulic pressure of 100 mm Hg in the maxillary artery was obtained by cannulating this artery via external dissection to the infratemporal fossa. The sphenopalatine artery and its immediate branches were identified endoscopically and perforated distal to the foramen with a 21G spinal needle. Control (without device in place) and study (with device in place) flow were evaluated endoscopically for the amount of penetration to the nasal cavity of dye-enhanced normal saline. Four sequential insertions and removals of the device were tested.Results: The placement of the SinuStat device into the sphenopalatine foramen, compared to control flow, resulted in complete or near complete cessation of flow in 4 of 4 insertions. Conclusion:In the model studied, the SinuStat temporary sphenopalatine artery occlusion device completely or nearcompletely occludes flow from the sphenopalatine ...

We report a rare case of a postoperative bilateral laryngeal and pharyngeal lesion of the extracranial vagal nerve following a routine general anaesthesia in prone position. It documents a possible way of a serious complication depending to the positioning of the patient in prone position. Etiological factors and measures to avoid this rare but critical complication are discussed.For the clinical practise it should give an advice to minimize the risk of injuries by malpositioning.Keywords: Prone position, malpositioning, complications, vagal nerve lesion, general anaesthesia. CASEPerioperative complications such as nerve lesions secondary to malpositioning may lead to severe functional disability of the patient and reduce a successful surgical procedure. These regrettable injuries that result from stretching, retraction and/or compression to soft tissue and peripheral nerves are especially true for surgery in prone position [1,2]. We present this rare case of a postoperative bilateral lesion of the extracranial vagal nerve following a routine general anaesthesia in prone position to demonstrate possible ways in which nerves can be damaged in the perioperative phase.A 56 year old, 62 kg weighted woman with a 2 year history of frequent lower back pain presented increasing pain and hypaesthesia of both lower extremities as well as a dyfunction of the urinary bladder for the last 2 months. Radiological imaging showed the lumbal stenosis of L3/4 and L4/5 and the instable degenerative lumbal spondylodesis of L3-5. The neurological deficits indicated neurosurgical decompression of lumbal stenosis and transpedicular stabilization of the lumbal spondylodesis. At admission to the surgical treatment the patient was in good physiological condition. 4 years ago a chronic lymphatic leukaemia (CLL) was detected. The Bcell CLL was diagnosed in an early stage (smoldering Binet A) and was not treated with systemic chemotherapy. She presented a peripheral leucocyte count of 28,000 per μl, 158,000 thrombocytes per μl and a hemoglobine count of 12,2 g/l. Different surgical procedures such as hysterectomy, and total endoprothesis of the right knee joint secondary to gonarthrosis were performed in the past years without significant complications.We introduced general anaesthesia with 20 μg of Sufentanil, 80 mg of Propofol and 30 mg of Rocuronium. The orotracheal intubation proved to be uncomplicated. The orotracheal *Address correspondence to this author at the Department of Anesthesiology and Intensive Care, Hospital of Ludwigsburg, Posilipostr. 4, D-71640 Ludwigsburg, Germany; E-mail: nauhdi01@kliniken-lb.de tubus measured an internal diameter of 7,0 mm and was fixed on the left side of the mouth. The cuff was inflated with air up to 22 cmH 2 O and cuff pressure was monitored continuously using a manometer connected to the cuff pilot balloon. Anaesthesia was maintained with Isoflurane (0,6-0,7 vol.% in exspiration), air-oxygen-inflation with an oxygen-fraction of 100% before and 50% performed in low flow after positioning ...