Use of balloon catheter dilation vs. traditional endoscopic sinus surgery in management of light and severe chronic rhinosinusitis of the frontal sinus: a multicenter prospective randomized study

OBJECTIVE: Chronic rhinosinusitis (CRS) of the frontal sinus is a complex pathological condition and many surgical techniques were described to treat this area endoscopically, like traditional endoscopic sinus surgery (ESS) and balloon catheter dilation (BCD). PATIENTS AND METHODS: We designed a multicenter prospective randomized study to assess the validity and safety of BCD vs. ESS in symptomatological chronic rhinosinusitis of the frontal sinus enrolling a population of 102 adult patients (64 men and 38 women; overall 148 frontal sinuses studied) with non-polypoid CRS. For a better evaluation of the disease, in our study we decided to analyze both radiological (Lund-McKay CT scoring modified by Zinreich) and symptomatological results (SNOT-20 questionnaire). We divided the population affected in two groups, one with light/mild frontal CRS and the other with moderate/severe frontal CRS, basing on radiological findings at Lund-MacKay modified by Zinreich score. Every group was divided in two subgroups, in one we used BCD and in the other we used traditional ESS. RESULTS: The current literature does not support the suggestion that indications for BCD and ESS are identical, and additional research is needed to determine the role for BCD in specific patient populations. The results showed a not statistically significative difference between BCD and conventional ESS of the frontal sinus in patients with light/mild CRS and in patients with moderate/severe CRS at Lund-Mackay modified by Zinreich score. The same not statistically significative difference was observed comparing the results of SNOT-20 questionnaire in the group of light/mild frontal chronic rhinosinusitis. However, we noticed a statistically significant better outcome of SNOT-20 score in patients with moderate/severe chronic rhinosinusitis that underwent BCD of frontal sinus compared to ESS. CONCLUSIONS: BCD and ESS are two alternative weapons in the baggage of every endoscopic surgeon, even because they present similar outcomes, safeness and effectiveness both in light/mild and moderate/severe chronic rhinosinusitis of the frontal sinus. An interesting result of our study was the statistically significant better outcome of SNOT-20 score in patients that underwent BCD of frontal sinus for a moderate/severe CRS, compared to those that underwent a traditional ESS

Dielectric Response of a Variable Saturated Soil Contaminated by Non-Aqueous Phase Liquids (NAPLs)

AbstractIn recent years, several studies have been conducted both in saturated and unsaturated soils to detect non-aqueous phase liquid (NAPL) hydrocarbon contamination in soils and groundwater by means of the time domain reflectometry (TDR) technique. This technique is widely used for measuring the dielectric permittivity and bulk electrical conductivity of multiphase systems. Only accurate knowledge of the dielectric response of soil matrix- water-NAPL (saturated condition) or soil matrix-air-water-NAPL (unsaturated condition) systems can allow the volumetric NAPL content (θNAPL) to be determined in the soil. This paper investigates the influence of NAPL contamination (corn oil, a non-volatile and non-toxic NAPL, was used) on TDR measurement in a volcanic soil, relating dielectric permittivity of the multiphase soil system to volumetric fluid content θf (i.e. water+NAPL). The soil samples were oven dried at 105°C and passed through a 2mm sieve. Known quantities of soil, water and oil were mixed and repacked into plastic cylinders (15cm high and 9.5cm in diameter); 40 different combinations of water and oil were tested, with θNAPL varying from 0.05 to 0.40 by 0.05cm3/cm3 increments. A volumetric mixing model with three (soil matrix-water-NAPL) or four (soil matrix-air-water-NAPL) phases permitted conversion from a dielectric permittivity domain into a θf domain. The results show that, the amount of contaminant in soil can be inferred if the total volume of pore fluid θf and the dielectric permittivity of the contaminated soil are known. Further work will be built on this initial study, concentrating on: i) enhancing the model linkage and validating it with new laboratory results; ii) validating the developed TDR interpretation tool with field results

Impact of olive mill wastewater (OMW) on the soil hydraulic and solute transport properties

The Mediterranean area concentrates the world’s largest production area of olive oil. The olive oil industry represents, in this basin, one of the leading sectors of the agri-food economy. Olive mill water (OMW) is the principal waste effluent produced by the olive oil industry. Due to its high pollution load, this aqueous by-product cannot be directly disposed of in domestic wastewater treatment plants (especially those with a biological treatment unit). Untreated OMW is currently used for agronomic purposes in several countries, mainly because it is rich in valuable plant nutrients. However, OMW is characterized by toxic phenols, high organic matter, high salinity, suspended solids and several other components that may have possible negative effects on chemical and physical soil properties, as well as soil biological activities. In the present research, we focused on the effects of OMW application on transport and hydraulic soil properties. Three distinct soils from a pedological point of view were selected and a series of laboratory steady-state miscible flow tests were conducted under saturated conditions, on both OMW-treated and -untreated soil columns. Tests were conducted on disturbed and undisturbed soil columns. The approach proposed by Kachanoski, based on soil impedance (Z) measurements via the time domain reflectometry (TDR) technique, was used to monitor the leaching experiments. The breakthrough curves (BTCs) exhibited different shapes that allowed the repercussions of OMW applications on soil transport behaviour to be distinguished. Several additional tests conducted on OMW-treated and -untreated soil cores to determine water retention curves (SWRCs) and saturated hydraulic conductivity Ks allowed us to infer the probable mechanisms involved in soil hydrological behaviour changes under OMW treatments. The results show that when OMW leaches into the soil immediately after its disposal there is little effect on the evaluated hydraulic and hydrodispersive properties. By contrast, we demonstrated that a short incubation period (i.e. a short contact time between OMW and soil) of 10 days is enough to exert a great influence on all the values determined (e.g. soil pore velocity v and Ks reduced by up to one order of magnitude). These effects were especially evident in undisturbed soil samples. Graphic Abstract: [Figure not available: see fulltext.

A soil non-aqueous phase liquid (NAPL) flushing laboratory experiment based on measuring the dielectric properties of soil-organic mixtures via time domain reflectometry (TDR)

The term non-aqueous phase liquid (NAPL) refers to a group of organic compounds with scarce solubility in water. They are the products of various human activities and may be accidentally introduced into the soil system. Given their toxicity level and high mobility, NAPLs constitute a serious geo-environmental problem. Contaminant distribution in the soil and groundwater contains fundamental information for the remediation of polluted soil sites. The present research explored the possible employment of time domain reflectometry (TDR) to estimate pollutant removal in a silt-loam soil that was primarily contaminated with a corn oil as a light NAPL and then flushed with different washing solutions. Known mixtures of soil and NAPL were prepared in the laboratory to achieve soil specimens with varying pollution levels. The prepared soil samples were repacked into plastic cylinders and then placed in testing cells. Washing solutions were then injected upward into the contaminated sample, and both the quantity of remediated NAPL and the bulk dielectric permittivity of the soil sample were determined. The above data were also used to calibrate and validate a dielectric model (the α mixing model) which permits the volumetric NAPL content (θNAPL m3 m-3) within the contaminated sample to be determined and quantified during the different decontamination stages. Our results demonstrate that during a decontamination process, the TDR device is NAPL-sensitive: the dielectric permittivity of the medium increases as the NAPL volume decreases. Moreover, decontamination progression can be monitored using a simple (one-parameter) mixing model

In situ estimation of soil hydraulic and hydrodispersive properties by inversion of electromagnetic induction measurements and soil hydrological modeling

Soil hydraulic and hydrodispersive properties are necessary for modeling water and solute fluxes in agricultural and environmental systems. Despite the major efforts in developing methods (e.g., laboratory-based, pedotransfer functions), their characterization at applicative scales remains an imperative requirement. Accordingly, this paper proposes a noninvasive in situ method integrating electromagnetic induction (EMI) and hydrological modeling to estimate soil hydraulic and transport properties at the plot scale. To this end, we carried out two sequential water infiltration and solute transport experiments and conducted time-lapse EMI surveys using a CMD Mini-Explorer to examine how well this methodology can be used to (i) monitor water content dynamic after irrigation and to estimate the soil hydraulic van Genuchten-Mualem parameters from the water infiltration experiment as well as (ii) to monitor solute concentration and to estimate solute dispersivity from the solute transport experiment. We then compared the results with those estimated by direct time domain reflectometry (TDR) and tensiometer probe measurements. The EMI significantly underestimated the water content distribution observed by TDR, but the water content evolved similarly over time. This introduced two main effects on soil hydraulic properties obtained by the two methods: (i) similar water retention curve shapes, but underestimated saturated water content from the EMI method, resulting in a scaled water retention curve when compared with the TDR method; the EMI-based water retention curve can be scaled by measuring the actual saturated water content at the end of the experiment with TDR probes or by weighing soil samples; (ii) almost overlapping hydraulic conductivity curves, as expected when considering that the shape of the hydraulic conductivity curve primarily reflects changes in water content over time. Nevertheless, EMI-based estimations of soil hydraulic properties and transport properties were found to be fairly accurate in comparison with those obtained from direct TDR measurements and tensiometer probe measurements

Impact of zeolite from coal fly ash on soil hydrophysical properties and plant growth

Zeolites can be extensively employed in agricultural activities because they improve soil properties such as infiltration rates, saturated hydraulic conductivity, water holding capacity, and cation exchange capacity. Natural and synthetic zeolites can efficiently hold water. Zeolites are also believed to have the ability to lose and gain water reversibly, without changing their crystal structure. In the present study, several laboratory tests were carried out using: (i) zeolite synthesized from coal fly ash (a waste product from burning coal in thermoelectric power plants), (ii) a silty loam soil, typically found in Southern Italy, and (iii) sunflower as a reference plant. The selected soil was amended with different percentages of zeolite (1, 2, 5, and 10%) and the effects of the synthetic mineral addition on the hydrophysical properties of the soil and plant growth were evaluated. The results indicated that soil–zeolite mixtures retained water more efficiently by pore radius modification. However, this causes a variation in the range of plant-available water towards higher soil humidity values, as the amount of added zeolite increases. These data confirm that zeolite addition modifies the selected hydrophysical properties of the soil with the effect of decreasing the soil drainage capacity, making the soil less habitable for plant growt

Endoscopic resection of sinonasal inverted papilloma: a multivariate retrospective analysis of factors affecting recurrence and persistence

Sinonasal inverted papilloma (IP) is the most common benign epithelial tumor in the nasal cavity and paranasal sinuses, with a worldwide incidence between 0.6 and 1.5/100 000 persons per year. However, only a few studies have investigated patient-dependent factors related to IP recurrence and persistence. According to available evidence, these factors are still debated, and results are contradictory. In this multicenter retrospective study, we analyzed the clinical records of 130 patients who were surgically treated for sinonasal IP to evaluate the factors affecting recurrence and persistence of IP and compared the curative rates of different surgical approaches. Our analysis showed that IP recurrence is strongly related to specific risk factors including incomplete surgical removal, stage of disease, site of the lesion, surgical technique, and malignancy rate. In conclusion, the recurrence of IP may be affected by several risk factors; these factors must be carefully considered during clinical evaluation and especially during the follow-up of patients with IP

A Stochastic Texture-based Approach for Evaluating Solute Travel Times to Groundwater at Regional Scale by Coupling GIS and Transfer Function

AbstractInterpreting and predicting the evolution of non-point source (NPS) pollution of soil and surface and subsurface water from agricultural chemicals and pathogens, as well as overexploitation of groundwater resources at regional scale are continuing challenges for natural scientists. The presence and build up of NPS pollutants may be harmful for both soil and groundwater resources. Accordingly, this study mainly aims to developing a regional-scale simulation methodology for groundwater vulnerability that use real soil profiles data. A stochastic approach will be applied to account for the effect of vertical heterogeneity on variability of solute transport in the vadose zone. The approach relies on available datasets and offers quantitative answers to soil and groundwater vulnerability to non-point source of chemicals at regional scale within a defined confidence interval. The study area is located in the Metaponto agricultural site, Basilicata Region-South Italy, covering approximately 12000 hectares. Chloride will be considered as a generic pollutant for simulation purposes. The methodology is based on three sequential steps: 1) designing and building of a spatial database containing environmental and physical information regarding the study area, 2) developing travel time distributions for specific textural sequences in the soil profile, coming from texture-based transfer functions, 3) final representation of results through digital mapping. Distributed output of soil pollutant leaching behavior, with corresponding statistical uncertainties, will be visualized in GIS maps. Of course, this regional-scale methodology may be extended to any specific pollutants for any soil, climatic and land use conditions

Assessing the dynamics of soil salinity with time-lapse inversion of electromagnetic data guided by hydrological modelling

Irrigated agriculture is threatened by soil salinity in numerous arid and semi-Arid areas of the world, chiefly caused by the use of highly salinity irrigation water, compounded by excessive evapotranspiration. Given this threat, efficient field assessment methods are needed to monitor the dynamics of soil salinity in salt-Affected irrigated lands and evaluate the performance of management strategies. In this study, we report on the results of an irrigation experiment with the main objective of evaluating time-lapse inversion of electromagnetic induction (EMI) data and hydrological modelling in field assessment of soil salinity dynamics. Four experimental plots were established and irrigated 12 times during a 2-month period, with water at four different salinity levels (1, 4, 8 and 12 dS m-1) using a drip irrigation system. Time-lapse apparent electrical conductivity (σa) data were collected four times during the experiment period using the CMD Mini-Explorer. Prior to inversion of time-lapse σa data, a numerical experiment was performed by 2D simulations of the water and solute infiltration and redistribution process in synthetic transects, generated by using the statistical distribution of the hydraulic properties in the study area. These simulations gave known spatio-Temporal distribution of water contents and solute concentrations and thus of bulk electrical conductivity (σb), which in turn were used to obtain known structures of apparent electrical conductivity, σa. These synthetic distributions were used for a preliminary understanding of how the physical context may influence the EMI-based σa readings carried out in the monitored transects as well as being used to optimize the smoothing parameter to be used in the inversion of σa readings. With this prior information at hand, we inverted the time-lapse field σa data and interpreted the results in terms of concentration distributions over time. The proposed approach, using preliminary hydrological simulations to understand the potential role of the variability of the physical system to be monitored by EMI, may actually allow for a better choice of the inversion parameters and interpretation of EMI readings, thus increasing the potentiality of using the electromagnetic induction technique for rapid and non-invasive investigation of spatio-Temporal variability in soil salinity over large areas.