The delivery of nasal drugs specifically to the middle meatus is of critical importance in the medical treatment of rhinosinusitis. In this respect, topical nasal drug administration by drops has generally been perceived to be superior to nasal sprays, although there is a lack of evidence to support this notion. This study aims to compare the intranasal delivery of nasal sprays and drops to the middle meatus in vivo, using a novel quantitative method. A surgical patty was placed in the middle meatus. Radio-labelled topical nasal drops and aqueous sprays were administered in a standardized fashion in normal volunteers (10 nasal cavities). The subsequent absorption of administered radio-labelled saline on the patty was measured using a gamma counter. A randomized prospective crossover design was used for the study. The mean percentage (range) of absorbed administered saline on the swab was 8.7 (0.3-39.5) and 9.7 (0.03-20.4) for the spray and drop administration techniques respectively (p = 0.8). Thus, there is wide variation in the delivery of topical nasal drugs and the perceived superiority of nasal drop administration, in terms of delivery to the middle meatus, may be incorrect.
Objective: To compare the extent of thigh haematoma formation after perforation-invagination (PIN) stripping with that occurring after standard plication stripping of the long saphenous vein. Design: Prospective, within-case, randomised study with analysis on an intention-to-treat basis. Setting: The radioisotope department of a university teaching hospital. Patients: Fourteen patients undergoing bilateral varicose vein surgery. Interventions: Red blood cell labelling in vivo with 99Tcm. Preoperative imaging of the long saphenous vein using a gamma camera. Randomisation of one leg to PIN stripping and the other to standard stripping of the long saphenous vein to the knee. Patients were reimaged 6 h postoperatively. Main outcome measures: The extent of thigh haematoma formation. Results: There was no significant difference with respect to the severity of varicosities in the long saphenous vein in the thigh between the limbs assigned to each group ( n = 11) on the preoperative images ( T = 25, 0.5> p>0.1, Wilcoxon signed rank test). Thigh haematoma in the limbs that had undergone PIN stripping of the long saphenous vein was significantly less than that in the limbs that had undergone standard stripping (T = 10, 0.05> p>0.01, Wilcoxon signed rank test). Conclusion: PIN stripping of the long saphenous vein results in significantly decreased haematoma formation compared with standard stripping.
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