Surgical Management of Congenital Nasal Pyriform Aperture Stenosis: A Case Report

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of respiratory distress in newborns. This paper reports a case of severe CNPAS that required endotracheal intubation immediately after birth, and eventually, surgical intervention. At birth, the width of the pyriform aperture was only 4 mm, and the patient was completely unable to breathe through his nose. We performed tracheostomy at 23 days of age and waited for the patient to grow, but at 56 days of age, the width of the pyriform aperture was not sufficient (6 mm) for the patient to breathe through his nose. Therefore, surgical dilation of the pyriform aperture by a sublabial approach was performed on day 79 after birth, and the width was increased to 14 mm. Postoperative stent placement was performed for two weeks. After the removal of the stents, the patient could finally breathe through his nose, and the postoperative course was uneventful, with no restenosis after four months. CNPAS is a rare cause of nasal obstruction, but it can cause respiratory distress in infants because they are dependent on nasal breathing. Conservative treatments are initially recommended for CNPAS; however, in severe cases where conservative treatments are ineffective, surgical treatment is recommended

Characteristics of the ice pellets observed in mid-winter in the Arctic region

In mid-winter ice pellets were observed at Inuvik, Canada and Kiruna, Sweden in the Arctic region. The size distribution, morphology and crystalline nature were examined from the photomicrographs. Moreover, meteorological conditions in which the ice pellets could form were examined from the sounding data at Inuvik. The following results were obtained. (1) The sizes of ice pellets in the Arctic regions were considerably smaller than those in temperate regions. (2) The ice pellets simultaneously fell with the snow crystals with frozen small raindrops. (3) The morphology of ice pellets with a bulge or a spike was qualitatively similar to the results of laboratory experiments. (4) The rate of shattering was smaller than the results of laboratory experiments. (5) Single crystalline ice pellets were abundant in the size < 200μm. (6) Ice pellets in the Arctic are formed through the freezing of supercooled drizzle drops, which are formed by condensation-coalescence process below the freezing temperature