phenylephrine-hydrochloride and Obesity

Topics: Adult; Airway Remodeling; Child; Craniofacial Abnormalities; Disease Progression; Humans; Nasal Obstruction; Nose; Nose Deformities, Acquired; Obesity; Pharynx; Rhinitis; Risk Factors; Sleep Apnea, Obstructive; Trachea

Sleep disordered breathing (SDB) is a common condition and could be a risk factor for cardiovascular morbidity and mortality. However, the pathogenesis of SDB remains to be elucidated. In general, SDB is divided into two forms, obstructive and central sleep apnea (OSA and CSA, respectively). OSA results from the sleep-related collapse of the upper airway (UA) in association with multiple factors like race, gender, obesity and UA dimensions. CSA primarily results from a fall in PaCO2 to a level below the apnea threshold during sleep through the reflex inhibition of central respiratory drive. It has been reported that UA alterations (i.e., collapse or dilation) can be observed in CSA. This review highlights the roles of the UA in the pathogenesis and pathophysiology of SDB.

Topics: Airway Obstruction; Cardiovascular Diseases; Female; Humans; Male; Nasal Obstruction; Nose; Obesity; Palatal Muscles; Pharyngeal Muscles; Pharynx; Respiratory Mechanics; Risk Factors; Sex Factors; Sleep; Sleep Apnea, Central; Sleep Apnea, Obstructive; Wakefulness

Alobar holoprosencephaly is a rare and severe brain malformation due to early arrest in brain cleavage and rotation.. We report a congenital anomalous fetus with alobar holoprosencephaly, prenatally diagnosed by two-dimensional (2D) sonography at the 40 weeks of gestation. The mother was affected by gestational diabetes mellitus and was obese (BMI > 30 kg/m(2)). 2D Ultrasound depicted the cerebral malformation, cyclopy, proboscis, cardiac defects (atrial septal defect, hypoplastic left heart, anomalous communication between right ventricle and aorta) and extremities defects. The newborn died just after delivery. External examination confirmed a mobile proboscis-like nose on the normal nose position. The fetus had both claw hands. The right and left feet showed to be equine. Autopsy confirmed the ultrasound diagnosis and chromosome analysis revealed trisomy 13 (47,XY,+13). Fetopathologic examination showed cyclopy, proboscis and alobar holoprosencephaly of the fetus, which was consistent with Patau syndrome.. The teratogenic effect of diabetes on fetus has been described, but no previous clinical case of a congenital anomalous fetus with trisomy 13 and maternal gestational diabetes has been reported. This case report is the first to describe 2D ultrasound diagnosis of alobar holoprosencephaly and trisomy 13 with maternal gestational diabetes mellitus.

Topics: Adult; Chromosomes, Human, Pair 13; Diabetes, Gestational; Eye Abnormalities; Female; Heart Defects, Congenital; Holoprosencephaly; Humans; Infant, Newborn; Limb Deformities, Congenital; Nose; Obesity; Pregnancy; Trisomy; Ultrasonography, Prenatal

Topics: Adolescent; Adult; Body Image; Female; Humans; Nose; Obesity; Personal Satisfaction; Respiration; Stress, Psychological; Students; Treatment Outcome; Universities; Waist Circumference; Weight Loss; Yoga; Young Adult

Eating rate and bite size are important factors affecting food intake, and we hypothesise the underlying role of oral sensory exposure in this. However, the latter currently lacks objective measuring parameters, but an interesting measure could be the extent of in vivo retro-nasal aroma release. Second, the literature is ambiguous about overweight subjects differing from normal-weight subjects in eating behaviour. Consequently, we investigated: (1) whether eating behaviour (food intake, eating rate, bite size, number of bites and meal duration) relates to weight status and (2) whether the extent of retro-nasal aroma release relates to eating behaviour and weight status. A matched group (sex, age and dietary restraint) of twenty-seven normal-weight (BMI 21.8 (SD 1.6) kg/m2) and twenty-seven overweight/obese subjects (BMI 30.5 (SD 5.8) kg/m2) consumed a spiced rice meal and apple pie yogurt on separate test days. The extent of retro-nasal aroma release was measured on a third test day. Mean bite size for spiced rice was significantly (P = 0.03) larger in overweight/obese (10.3 (SD 3.2) g) v. normal-weight subjects (8.7 (SD 2.1) g). There were no other significant differences in eating behaviour or retro-nasal aroma release between the groups. Eating behaviours were not correlated with BMI or retro-nasal aroma release. Subjects showed consistent eating behaviour for both test products. Eating behaviour might be a characteristic of an individual but not by definition a characteristic for a group of people based on their weight. Given the large sample sizes, necessary according to a posteriori sample size calculations, one needs to consider the relevance of finding a statistically significant difference in eating behaviour between the weight groups in a laboratory setting.

Topics: Adult; Body Mass Index; Body Weight; Case-Control Studies; Cross-Over Studies; Diet; Energy Intake; Feeding Behavior; Female; Humans; Male; Mastication; Nose; Obesity; Odorants; Olfactory Perception; Pilot Projects; Reference Values

The purpose of this cross-sectional study is to examine the relationship between surgical treatments for sleep-disordered breathing (SDB) and composite measure of surgical complications in a nationally representative sample of hospital discharges among U.S. adults. We performed secondary analyses of 33,679 hospital discharges from the 2002-2012 Nationwide Inpatient Sample that corresponded to U.S. adults (≥18 years) who were free of head-and-neck neoplasms, were diagnosed with SDB and had undergone at least one of seven procedures. Multivariate logistic regression models were constructed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI), controlling for age, sex, race/ethnicity, obstructive sleep apnea (OSA) and obesity diagnoses. Positive associations were found between composite measure of surgical complications and specific procedures: palatal procedure (aOR = 12.69, 95% CI: 11.91,13.53), nasal surgery (aOR = 6.47, 95% CI: 5.99,6.99), transoral robotic assist (aOR = 5.06, 95% CI: 4.34-5.88), tongue base/hypopharynx (aOR = 4.24, 95% CI: 3.88,4.62), maxillomandibular advancement (MMA) (aOR = 3.24, 95% CI: 2.74,3.84), supraglottoplasty (aOR = 2.75, 95% CI: 1.81,4.19). By contrast, a negative association was found between composite measures of surgical complications and tracheostomy (aOR = 0.033, 95% CI: 0.031,0.035). In conclusion, most procedures for SDB, except tracheostomy, were positively associated with complications, whereby palatal procedures exhibited the strongest and supraglottoplasty exhibited the weakest association.

Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Female; Hospitalization; Humans; Logistic Models; Male; Mandibular Advancement; Middle Aged; Nose; Obesity; Odds Ratio; Palate; Postoperative Complications; Risk Factors; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Tongue; Tracheostomy; United States; Young Adult

It is known that obesity causes obstructive sleep apnea syndrome by increasing upper airway resistance. Also, obese patients are admitted to the ear, nose, and throat clinic very often because of nasal obstruction complaint. The aim of this study is to identify the change and relation among body mass index (BMI), nasal resistance, reduction in nasal ariflow, nasal anatomy, and patients' subjective complaints.. A total of 67 patients admitted to our clinic between August 2013 and January 2014 were included in the study.The study group comprised 33 patients who had a chief complaint-nasal obstruction and the other group consisted of 34 patients who had no complaint and nasal pathology. Both the groups were checked with acoustic rhinometry (AR), active anterior rhinomanometer, nasal obstruction symptom evaluation (NOSE), and visual analog study (VAS) questionnaire.. There is a significant statistical correlation between the body mass increase and VAS and NOSE score increase (P < 0.05). But the authors did not find any statistically significant relation between BMI and total inspiratory and expiratory MR and MF measured by anterior active rhinomanometer and left and right nasal cavity MCA, and volume measured by acoustic rhinometery (P > 0.05).. Contrary to belief, obesity does not change the nasal resistance, airflow, and anatomy but it can cause subjective nasal complaints.

Topics: Adolescent; Adult; Airway Resistance; Body Mass Index; Endoscopy; Exhalation; Female; Humans; Inhalation; Male; Middle Aged; Nasal Cavity; Nasal Obstruction; Nose; Obesity; Pulmonary Ventilation; Rhinomanometry; Rhinometry, Acoustic; Visual Analog Scale; Young Adult

Staphylococcus aureus nasal colonization is a risk factor for surgical site infection. We conducted a retrospective case-control study of 1,708 consecutively enrolled patients to identify criteria that places orthopaedic surgery patients undergoing spine and total joint arthroplasty surgery at risk for nasal colonization by MRSA and MSSA. Multivariate analysis showed obesity and asthma as significant risk factors for MRSA colonization. The identification of these two risk factors for MRSA colonization may help decolonization programs target patients with these factors for treatment prior to surgery, which could potentially lead to reductions in the rates of surgical site infections.

Topics: Arthroplasty, Replacement; Asthma; Databases, Factual; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Multivariate Analysis; Nose; Obesity; Odds Ratio; Orthopedic Procedures; Retrospective Studies; Risk Factors; Sex Factors; Spine; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome; White People

Given that tricho-rhino-phalangeal syndrome (TRPS) and pseudohypoparathyroidism/pseudopseudohypoparathyroidism (PHP/PPHP) are very rare monogenic disorders that share some features (distinctive facies, short stature, brachydactyly and, in some patients, intellectual disability) that lead to their misdiagnosis in some cases, our objective was to identify clinical, biochemical or radiological signs that could help to distinguish these two syndromes.. We report on two cases, which were referred to the Endocrinology and Pediatric Endocrinology Services for obesity. Clinical evaluation initially suggested the diagnosis of PHP-Ia [phenotype suggestive of Albright hereditary osteodystrophy (AHO) with parathyroid hormone (PTH) resistance] and PPHP (phenotype resembling AHO, without PTH resistance), but (epi)genetic analysis of the GNAS locus ruled out the suspected diagnosis. Further clinical re-evaluation prompted us to suspect TRPS, and this was confirmed genetically.. TRPS was mistakenly identified as PHP/PPHP because of the coexistence of obesity and brachydactyly, with PTH resistance in one of the cases. Specific traits such as sparse scalp hair and a pear-shaped nose, present in both cases, can be considered pathognomonic signs of TRPS, which could help us to reach a correct diagnosis.

Topics: Abnormalities, Multiple; Adult; Base Sequence; Brachydactyly; Child; Diagnosis, Differential; DNA Mutational Analysis; DNA-Binding Proteins; Female; Fingers; Hair; Hand; Humans; Molecular Sequence Data; Mutation; Nose; Obesity; Phenotype; Pseudopseudohypoparathyroidism; Repressor Proteins; Syndrome; Transcription Factors

Obesity and diabetes mellitus (DM) have been linked to increased risk of infections, and Staphylococcus aureus nasal colonization is a major risk factor for developing infections with the microbe. We therefore sought to find whether body mass index (BMI) and waist circumference (WC) could be associated with S. aureus colonization independent of DM.. S. aureus colonization was assessed by nasal swab cultures among 2,169 women and 1,709 men, aged 30-87 years, in the population-based Tromsø Staph and Skin Study in 2007-08. Height (cm), weight (kg), WC (cm), and glycated haemoglobin (HbA1c,%) were measured. Multivariable logistic regression analyses including information on DM, HbA1c, hormonal contraceptive use and other potential confounders were used.. In the female population, each 2.5 kg/m(2) increase in BMI was associated with a 7% higher odds of S. aureus nasal colonization (P = 0.01). When comparing obese and lean women aged 30-43 years, we observed that BMI ≥32.5 versus <22.5 kg/m(2) and WC ≥101 versus <80 cm was associated with a 2.60 and 2.12 times higher odds of S. aureus colonization, respectively (95% confidence intervals 1.35-4.98 and 1.17-3.85). Among men, high WC was also associated with S. aureus nasal colonization. The associations did not change significantly when the analysis was restricted to participants without signs of pre-diabetes (HbA1c <6.0%) among women and men, and to non-users of hormonal contraceptives among women.. Our results support that obesity is a possible determinant for S. aureus nasal colonization independent of DM, in particular for premenopausal women. The role of obesity at different ages and by sex should be addressed in future prospective studies of S. aureus colonization.

Topics: Adult; Aged; Aged, 80 and over; Body Mass Index; Colony Count, Microbial; Female; Humans; Male; Middle Aged; Norway; Nose; Obesity; Odds Ratio; Probability; Staphylococcus aureus; Waist Circumference

To estimate whether body mass index (BMI) affects the evaluation of nuchal translucency or the nasal bone during first-trimester ultrasound examination for aneuploidy risk assessment.. Six hundred ninety-four women with singleton gestations undergoing first-trimester aneuploidy risk-assessment ultrasound examinations were identified. Weight categories were defined as normal (body mass index [BMI] less than 25), overweight (25-29.9), and obese (at or above 30). chi, chi for trend, Student t test, one-way analysis of variance, and Pearson correlation were used for statistical analysis where appropriate to estimate the effect of BMI on first-trimester ultrasound examination. P<.05 was considered statistically significant.. Increasing BMI was significantly associated with an inadequate nasal-bone assessment (3% compared with 12.7%, P<.001), increased ultrasound examination time (15.23+/-8.09 minutes compared with 17.01+/-7.97 minutes, P=.028), and an increased need to perform a transvaginal ultrasound examination (23% compared with 41.8%, P<.001). Prior abdominal surgery was not significantly associated with nasal-bone assessment inadequacy (7.8% compared with 4.4%, P=.125), the need to perform transvaginal ultrasound examination (33.6% compared with 28.6%, P=.279), or longer examination time (16.22+/-8.6 minutes compared with 15.92+/-7.8 minutes, P=.704).. In singleton pregnancies, increased BMI is not associated with suboptimal visualization of nuchal translucency, but it is associated with a longer time to perform the first-trimester ultrasound examination for aneuploidy risk assessment, increased need for transvaginal ultrasound examination for nuchal-translucency visualization, and a lower likelihood of obtaining an adequate nasal-bone image. Previous abdominal surgery did not affect the ability to visualize the nasal bone.. II.

Topics: Adult; Aneuploidy; Body Mass Index; Female; Humans; Nose; Nuchal Translucency Measurement; Obesity; Overweight; Pregnancy; Time Factors

To study the role of adjunctive upper airway surgery in obese patients with obstructive sleep apnea (OSA) who were poorly compliant with continuous positive airway pressure (CPAP) therapy.. Retrospective study of obese patients with OSA and documented poor CPAP compliance who underwent noncurative upper airway surgery for anatomical obstruction. Data collected included polysomnogram (PSG) parameters, CPAP settings and compliance, and surgical complications.. An urban academic county hospital with an 8-bed sleep laboratory. Data were collected retrospectively from 2002 through 2005.. Subjects who met the following criteria: (1) documented OSA (apnea-hypopnea index [AHI] > or =5.0) treated with CPAP therapy, (2) poor CPAP compliance (<4 hours per night), (3) subjected to upper airway surgery, (4) repeated PSG after surgery revealed persistent OSA (AHI > or = 5) requiring continued treatment with CPAP, and (5) availability of presurgery and postsurgery CPAP compliance data.. Compliance with CPAP.. Data from 11 patients were available for analysis. Their PSG parameters revealed the mean AHI (79.0 before surgery vs 30.2 after surgery; P < .001) and mean CPAP pressure setting (11.8 cm H(2)O before surgery vs 10.4 cm H(2)O after surgery; P = .09) improved following surgery. A mean increase of 48.6 minutes in CPAP compliance was noted after surgery (P = .03). Eight of the 11 patients improved their CPAP compliance following surgical intervention, including 5 who improved by more than 1 hour.. Upper airway surgery in select patients with OSA may improve CPAP compliance and should be considered as a potential adjunctive therapeutic measure in poorly compliant patients with OSA.

Topics: Adult; Aged; Continuous Positive Airway Pressure; Female; Humans; Male; Middle Aged; Nose; Obesity; Oral Surgical Procedures; Patient Compliance; Pilot Projects; Polysomnography; Retrospective Studies; Sleep Apnea, Obstructive; Tonsillectomy; Treatment Outcome

Topics: Airway Resistance; Body Mass Index; Humans; Mouth; Mouth Breathing; Nose; Obesity; Otorhinolaryngologic Diseases; Polysomnography; Sleep Apnea Syndromes

A new case of Hernandez syndrome is described in a 16-year-old Brazilian girl. The syndrome consists mainly of psychomotor retardation, epilepsy, a bulbous nose and obesity.

Topics: Adolescent; Developmental Disabilities; Epilepsy; Female; Humans; Nose; Obesity; Psychomotor Performance; Syndrome

Obstructive Sleep Apnea (OSA), Obesity-Linked Hypoventilation (OLH)--a hypoventilation which is independent of apneas and increased by sleep--, and COPD are mechanisms for respiratory failure in obese patients. We thought nasal bi-level positive airway pressure to be a suitable treatment: EPAP is useful to maintain upper airway patency and IPAP-EPAP difference to correct OLH and COPD hypoventilation. Our purpose is to report the results of such a therapeutic approach. We included 41 patients that we first treated by nasal bi-level positive airway pressure for a respiratory failure with an uncompensated respiratory acidosis. The initial setting was about 4 cm H2O for EPAP and 16 for IPAP. Under supervision of a real-time printed oximetry tracing, we furthermore increased EPAP until disappearance of repetitive dips in oxygen saturation (that we assimilated to obstructive events) and IPAP until obtaining an acceptable level of steady saturation (we assimilated a low level to a steady hypoventilation). Age (mean +/- SD) was 63 +/- 11 years, BMI 42 +/- 9 kg/m2, pH 7.32 +/- 0.04, PaCO2 71 +/- 13 mmHg, PaO2 45 +/- 7 mmHg. Thirty-nine out of 41 patients returned home without need for tracheal intubation. At 7 days of treatment, PaCO2 was 50 +/- 6 mmHg. Thus, nasal bi-level position airway pressure appears to be an efficient treatment in these patients.

Topics: Acidosis, Respiratory; Adult; Age Factors; Aged; Body Mass Index; Carbon Dioxide; Female; Humans; Hypoventilation; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Obesity; Oxygen; Oxygen Inhalation Therapy; Peak Expiratory Flow Rate; Polysomnography; Positive-Pressure Respiration; Respiratory Insufficiency; Sleep Apnea Syndromes

A cephalometric analysis according to Hasund, supplemented by special obstructive sleep apnoea syndrome (OSAS) parameters, was performed on 169 patients who had been referred from the sleep laboratory. Statistical analysis showed a correlation between specific cephalometric landmarks including posterior airway space (PAS), a soft palate length, hyoid position and posterior growth development of the mandible and OSAS severity. A principal component analysis differentiated between four subgroups of OSAS patients: (1) orthognathic obese subjects; (2) patients with a long soft palate and low-positioned hyoid; (3) retrognathic patients with narrow PAS; and (4) prognathic ones. Lateral cephalometry is an important contribution to OSAS diagnostics and oral and maxillofacial therapy procedures.

Topics: Adult; Age Factors; Aged; Cephalometry; Female; Humans; Hyoid Bone; Hyperplasia; Male; Mandible; Maxilla; Middle Aged; Nasopharynx; Nose; Obesity; Palate, Soft; Palatine Tonsil; Prognathism; Retrognathia; Sleep Apnea Syndromes

Interactions between upper airway structure and posture in relation to obesity were studied in a sample of 61 adult Class I skeletal type male patients with obstructive sleep apnea (OSA) and 10 homologous control subjects. A pair of upright and supine lateral cephalometric films were taken for each subject. A Pearson correlation analysis identified significant r values for several demographic variables in patients with OSA such as apnea and hypopnea index, percentage of predicted neck circumference, minimum arterial oxygen saturation, and body mass index (BMI). The difference between cephalometric variables identified in upright and supine subjects was calculated. When patients with OSA changed their posture from upright to supine, significant correlations were observed between the cranial base to upper cervical column angle and the hypopharynx cross-sectional area and BMI. Moreover, the mandibular plane angle and the sella-nasion plane was significantly correlated with BMI. This occurred along with a significant positive correlation between the sella-nasion plane angle and BMI and a significant inverse correlation between the mandibular plane angle in reference to the absolute vertical and horizontal planes, with BMI after the positional change. Such correlations were not observed in control subjects. No correlations were observed between the variables related to the position of the hyoid bone with BMI in either patients with OSA or control subjects after the change in posture. On the basis of these findings, we propose that when patients with OSA change their body position from upright to supine (1) the patient's neck is more extended, and (2) the hyoid bone moves more anterosuperiorly in conjunction with an upward and forward rotation of the mandible. This change in craniofacial structure may be a compensatory geometrical change in the upper airway to secure its patency.

Topics: Adult; Airway Obstruction; Body Mass Index; Cephalometry; Cervical Vertebrae; Humans; Hyoid Bone; Hypopharynx; Male; Malocclusion; Mandible; Mouth; Neck; Nose; Obesity; Oxygen; Pharynx; Posture; Sella Turcica; Skull; Sleep Apnea Syndromes; Supine Position; Vertical Dimension

The incidence and pathogenesis of right ventricular dysfunction in obstructive sleep apnoea (OSA) remains controversial. Using nuclear ventriculography, the prevalence of right ventricular dysfunction (RVD) was therefore determined in obese patients with OSA, as well as their clinical characteristics, arterial blood gas values, spirometry and sleep parameters. The reversibility of RVD was evaluated after long-term use of nasal continuous positive airway pressure (nCPAP). We studied 112 obese patients with OSA by nuclear ventriculography, 35 with RVD (Group 1), 77 without RVD (Group 2), and 14 patients without OSA as controls (Group 3). Repeat nuclear ventriculography was performed in seven patients who used nCPAP nightly for 6-24 months. The mean right ventricular ejection fractions (RVEF) were 31%, 47% and 44% in Groups 1, 2 and 3, respectively. Group 1 also had a lower left ventricular ejection fraction (LVEF) of 55 vs 63% in Group 2. The OSA groups did not differ in mean spirometric or arterial blood gas values. Group 1 had a lower mean nocturnal arterial oxygen saturation (Sa,O2) of 82 vs 87% in Group 2, and a longer apnoea duration of 22.3 vs 19.2 s. All but two patients in Group 1 had either awake alveolar hypoventilation or an apnoea + hypopnoea index > 40 disordered breathing events.h-1. Repeat nuclear ventriculography after nCPAP revealed an increase in RVEF from 30 to 39%. In conclusion, right ventricular dysfunction is common in obstructive sleep apnoea, but it is reversible with nasal continuous positive airway pressure treatment and appears to be related to nocturnal oxygen desaturation.

Topics: Adult; Blood Gas Analysis; Female; Humans; Incidence; Male; Middle Aged; Nose; Obesity; Positive-Pressure Respiration; Prospective Studies; Radionuclide Ventriculography; Respiratory Function Tests; Risk Factors; Sex Distribution; Sleep Apnea Syndromes; Ventricular Dysfunction, Right

To examine if gender and airway resistance (nasal and pulmonary) influence the loudness and intensity of snoring, we prospectively studied 370 unselected patients referred to our sleep clinic because of heavy snoring and a possibility of sleep apnea. All patients had full nocturnal polysomnography, including measurements of snoring using a calibrated microphone-sound meter system, and determination of pulmonary (Raw) and nasal resistance (Rna). Snoring was quantified by reporting the number of snores per hour of sleep (snoring index--SI) and the maximum nocturnal sound intensity (dBmax). The patient population comprised 77 females and 293 males, ranging in age from 12 to 80 years. Based on the apnea/hypopnea index (AHI) we separated all patients into the apneic and non-apneic groups. There were 201 non-apneic snorers (AHI less than or equal to 10) and 160 apneic snorers (AHI greater than 10). There was no significant difference in snoring frequency, maximum nocturnal sound intensity, nasal and pulmonary resistance between men and women or between apneic and non-apneic snorers. Stepwise, forward, multiple linear regression analysis showed that body mass index and nasal resistance correlate significantly with the snoring index (R2 = 0.29, p less than 0.005), while age and body mass index correlate only weakly, but significantly, with the maximum nocturnal sound intensity. We conclude that (1) men snore similarly to women, and (2) obesity and nasal resistance are important determinants of the frequency of snoring. It follows that measures taken to reduce weight and decrease nasal resistance may be of benefit in reducing snoring.

Topics: Adolescent; Adult; Age Factors; Aged; Airway Resistance; Analysis of Variance; Child; Female; Humans; Linear Models; Lung; Male; Middle Aged; Nasal Obstruction; Nose; Obesity; Prospective Studies; Sex Factors; Sleep Apnea Syndromes; Snoring; Sound

Topics: Breast Diseases; Congenital Abnormalities; Humans; Nevus; Nevus, Pigmented; Nose; Nose Deformities, Acquired; Obesity; Plastics; Prognathism; Skin Neoplasms; Surgery, Plastic

Topics: Animals; Mice; Mice, Obese; Nasal Cavity; Nose; Obesity; Paranasal Sinuses