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Hassan H Ramadan

Publications and source records attributed to Hassan H Ramadan.

13 recordsLinked to original sources
PubMed2006

Detection of fungi in the sinus mucosa using polymerase chain reaction.

OBJECTIVE: To compare the presence of fungi in the sinus mucosa of patients with and without chronic rhinosinusitis. STUDY DESIGN AND SETTING: Prospective observational study using polymerase chain reaction and conventional culture to detect fungi in the sinus mucosa. Middle meatus mucosal samples were collected from 31 patients with chronic rhinosinusitis and 14 control subjects. RESULTS: Fungi were detected in 6.5% of subjects with chronic rhinosinusitis and in none of the control subjects using polymerase chain reaction. Fungi were detected in 29% of subjects with the combination of inhalant allergies, nasal polyposis, and asthma. Fungi were detected in none of the subjects without the combination of these three comorbidities (P = 0.03). CONCLUSION: Polymerase chain reaction assay appears to be able to detect fungi in chronic rhinosinusitis. SIGNIFICANCE: Fungi may not be implicated in the pathogenesis of most chronic rhinosinusitis. EBM RATING: B-3b.

Chronic Disease↗
PubMed2006

Nasal and paranasal sinus carcinoma: how can we continue to make progress?

PURPOSE OF REVIEW: New developments in the nasal and paranasal sinus cancers are reviewed. RECENT FINDINGS: In addition to woodworking, several risk factors for nasal and paranasal sinus cancers have been identified, most notably smoking. Progress in the differential diagnosis of small round cell nasal and paranasal sinus cancers allows the precise diagnosis of esthesioneuroblastoma. Despite recent improvements, T staging for ethmoid and nasal cavity needs refinement. An association of surgery and radiation therapy remains the best treatment modality. Major developments include endoscopic resection of nasal and paranasal sinus cancers, high-precision radiotherapy techniques such as intensity-modulated radiotherapy, and proton-beam radiotherapy. There is probably no role for chemotherapy in esthesioneuroblastoma. Although chemotherapy is important for aggressive neoplasms, its generalized use for nasal and paranasal sinus cancers awaits the application/development of newer drugs. These drugs might be applied locally since the majority of recurrences remain local. SUMMARY: Progress in the treatment of nasal and paranasal sinus cancers could be achieved through better prevention and the developments of more selective treatments such as endoscopic resection, high-precision radiotherapy, and new chemotherapy drugs.

Carcinoma↗
PubMed2005

Chronic rhinosinusitis and biofilms.

BACKGROUND AND HYPOTHESIS: Biofilms have been implicated in several head and neck infectious processes such as the following: dental and periodontal disease, otitis media, tympanostomy tube otorrhea, and chronic tonsillitis. We believe that biofilms also are associated with chronic rhinosinusitis. No information is known regarding the presence of biofilms in chronic rhinosinusitis. STUDY DESIGN AND SETTING: With institutional review board approval, tissue was obtained from consenting chronic rhinosinusitis patients who were undergoing functional endoscopic sinus surgery. Specimens were taken bilaterally from the ethmoid and maxillary sinuses. Inclusion criteria consisted of a positive diagnosis with pathologic tissue confirmation of chronic inflammation. Diagnosis was based on patient history, physical exam, and coronal sinus CT findings. Once collected, the specimens were labeled and fixed in formalin. The specimens were subsequently dehydrated, with successive immersions in increasing concentrations of diluted ethanol. The specimens were allowed to air dry and then were affixed to aluminum stubs with colloidal carbon. The sample surface was coated with a gold and palladium layer. The specimens were examined under an electron microscope. Areas of interest were photographed. RESULTS: Specimens from 5 patients were examined. All revealed bacterial biofilms. Invariably, biofilms were seen in the ethmoid, as well as in other samples. Denudation of ciliated and goblet cells was noted in all specimens. Biofilms resembled that of Staphylococcus species. Unidentified biofilms were also seen. CONCLUSIONS: This is the first documentation of biofilms in association with chronic rhinosinusitis. Further investigation is warranted, especially with control research subjects.

Adult↗
PubMed2005

Bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis.

OBJECTIVES: Biofilms are bacterial pathogens that organize in several chronic and recalcitrant infectious processes. We hypothesize that biofilms play a role in chronic rhinosinusitis (CRS). Our goal is to demonstrate biofilms in mucosal specimens of patients undergoing surgery for CRS. STUDY DESIGN: A prospective study of the presence of biofilms in patients undergoing endoscopic sinus surgery for CRS compared with control patients without CRS. METHODS: There were a total of 30 subjects and 4 controls enrolled. The samples of 24 subjects and 4 controls were cultured and then prepared using standard methods for scanning electron microscopy (SEM). The remaining six subjects' samples were treated using advanced cryofixation methods as preparation to preserve structure for SEM and transmission electron microscopy (TEM). RESULTS: Using strict SEM morphologic criteria, 24 (80%) of the 30 patients were found to have micrographic evidence of biofilms. All controls had healthy appearing cilia and goblet cells without biofilms. The six cryofixation samples showed biofilm structures on SEM micrographs that were correlated with bacterial structures seen at the mucosal surface on the corresponding TEM cross sections. Bacterial cultures were positive on all patients. CONCLUSIONS: Biofilms were demonstrated to be present in patients undergoing surgery for CRS; none of the patients without CRS had any evidence of biofilms. Although SEM is capable of demonstrating the biofilms' three-dimensional structure, glycocalyx, and water channels, it cannot clearly demonstrate the presence of bacteria within the biofilm. We were able to demonstrate evidence of bacteria in the biofilms on the subjects tested using TEM.

Adolescent↗
PubMed2005

Pediatric sinusitis: update.

Sinusitis in children is a very common condition. It is being seen more and more by primary care physicians and pediatricians. Children average six to eight colds per year. Of those, 0.5 to 5% will develop a sinus infection. Symptoms of a cold or allergy overlap with those of rhinosinusitis in the child. Distinguishing rhinosinusitis from a cold or allergy may be challenging. It is agreed that if cold symptoms are not improving by 7 to 10 days, a sinus infection should be seriously considered. Plain radiographs can be helpful for maxillary sinusitis especially if an air-fluid level is seen; otherwise, the sensitivity and specificity of plain radiographs are poor. Computed tomography (CT) should not be used for diagnostic purposes. The role of CTis mainly in children with chronic rhinosinusitis when surgery is being considered. In cases of complicated sinusitis, a CT scan is necessary. Treatment of most rhinosinusitis cases in children is medical. Antibiotics constitute the mainstay of medical treatment. Medical treatment should be with an appropriate antibiotic and for at least 14 days. Adjunctive treatment with saline irrigations and topical and systemic decongestants may be helpful. Surgical intervention is necessary for complicated cases and for cases that do not respond to prolonged course of medical management. Currently adenoidectomy and endoscopic sinus surgery are the most common procedures used. Children needing surgical intervention are a small percentage because of the success of medical treatment. When and which surgical procedure to use are discussed in detail.

Adenoidectomy↗
PubMed2004

Surgical management of chronic sinusitis in children.

OBJECTIVES/HYPOTHESIS: The objective was to compare three common surgical modalities in children for the treatment of chronic sinusitis that is refractory to medical management. STUDY DESIGN: Prospective nonrandomized study in a pediatric otolaryngology tertiary service. METHODS: Two hundred two children who satisfied criteria for surgery and were referred over a 10-year period were studied. Children were divided into three surgical groups. Group 1 had both endoscopic sinus surgery and adenoidectomy, group 2 had endoscopic sinus surgery alone, and group 3 had adenoidectomy. After a follow-up period of 12 months, improvement of symptoms was assessed. RESULTS: One hundred eighty-three children had adequate follow-up. Eighty seven percent of children in group 1 had improved symptoms, compared with 75% in group 2 and 52% in group 3 (P < .0001). Multivariate analysis showed that surgical procedure was a predictor of success. Asthma, smoke exposure, and age were independent predictors of success. CONCLUSION: Children who fail medical therapy benefit from surgery. Following certain criteria, one can chose between adenoidectomy alone or endoscopic sinus surgery with adenoidectomy to optimize surgical treatment of these children.

Adenoidectomy↗
PubMed2003

Relation of age to outcome after endoscopic sinus surgery in children.

OBJECTIVE: To determine whether endoscopic sinus surgery (ESS) in children has a better outcome at a certain age. DESIGN AND SETTING: Cohort study in a tertiary care children's hospital. PATIENTS: Ninety-nine children who underwent ESS between January 1994 and June 1999. MAIN OUTCOME MEASURES: Determining ESS outcomes was based on answers to a questionnaire mailed to the caregivers at least 1 year after surgery. Outcomes were considered failures if children required revision surgery or if their symptoms were not improved. RESULTS: The overall ESS success rate was 82%. Univariate analysis of age and surgery outcome revealed that children older than 6 years had an 89% success rate but that children younger than 6 years had a 73% success rate (P =.04). Of the 99 patients, 11 (9%) required revision surgery. Among them, 9 were younger and 2 were older than 6 years (P =.008). Of the 4 children younger than 3 years, 3 (75%) required revision surgery. CONCLUSIONS: Endoscopic sinus surgery in children younger than 3 years was not successful but it was beneficial in children older than 6 years. It may be beneficial at any age if a complication from chronic sinusitis occurs; however, for children younger than 6 years, revision surgery may later be necessary.

Adolescent↗
PubMed2002

Role of anaerobes in chronic sinusitis: Will polymerase chain reaction solve the debate.

BACKGROUND: Bacteriology of chronic sinusitis continues to be a matter of debate, particularly the role of anaerobes. Some authors suggest that anaerobes play a significant role whereas others suggest a minimal role. Those who suggest a significant role argue that standard culture techniques are the culprits. OBJECTIVE: The purpose of this study was to use polymerase chain reaction (PCR) on sinus specimens for the presence of anaerobes and to compare them with standard culture techniques. METHODS: Sixty-four samples were obtained in a sterile fashion during sinus surgery and were sent for standard anaerobic cultures as well as anaerobic PCR analysis. RESULTS: Anaerobic bacteria were demonstrated in 5% of culture specimens, which is similar to recently published data. PCR identified anaerobic bacteria in 19% of the specimens (P = 0.01). CONCLUSION: PCR analysis of surgical samples obtained during endoscopic sinus surgery for chronic sinusitis identified a significantly higher incidence of anaerobes (x4) compared with standard anaerobic culture technique.

Adolescent↗
PubMed2002

Smoke exposure and outcome of endoscopic sinus surgery in children.

OBJECTIVE: The study goal was to determine whether cigarette smoke exposure in children who are undergoing endoscopic sinus surgery (ESS) for chronic sinusitis will have an impact on the outcome. DESIGN: We conducted a cohort study in a tertiary care children's hospital setting. PATIENTS AND METHODS: The study population consisted of 118 patients who underwent ESS between January 1994 and June 1999. The mean age was 6.5 (range, 2 to 13 years). The outcome of ESS was measured > or =1 year after the operation. A questionnaire was mailed to the caretakers to measure success. Those who required revision subsequently were considered as failures. RESULTS: Multivariate logistic regression analysis was performed with smoke exposure as an independent variable and outcome measured as success of procedure. The overall success rate was 83%. Univariate analysis of smoke exposure and outcome of surgery revealed that children exposed to smoke in household had a 70% success rate compared with children not exposed to smoke, who had a 90% success rate (P = 0.007). Multivariate analysis revealed smoke exposure continued to be an independent predictor of success. CONCLUSION: ESS in children with cigarette smoke exposure predisposes to a poorer outcome. This needs to be taken into consideration when recommending ESS for those children.

Adolescent↗
PubMedDate not supplied

Outcome of endoscopic sinus surgery in children with allergic rhinitis.

BACKGROUND: Allergic rhinitis (AR) is a morbid condition in children with chronic rhinosinusitis. The study goal was to determine whether children with AR who are undergoing endoscopic sinus surgery (ESS) will have a poor outcome. METHODS: The study population consisted of 141 patients who underwent ESS between January 1994 and December 2002. The outcome of ESS was measured at least 1 year after the operation. RESULTS: The overall success rate was 80%. Children with an allergy had 77% success rate compared with children with no allergy who had an 84% success rate (p = 0.25). Children with AR who were on treatment before surgery had an 84% success rate compared with 62% for those children with AR but were not treated (p = 0.022). CONCLUSION: ESS in children with AR does not have a poorer outcome. Treatment of the allergy before surgery may improve the success of ESS.

Adolescent↗
PubMedDate not supplied

Histologic and immunologic observations of viral-induced rhinosinusitis in the mouse.

Viral upper respiratory infection is one of the most common diagnoses made in primary care offices. Although symptoms resolve within 1 week for many patients, a percentage develops rhinosinusitis, and many of these patients are treated with antibiotics. We have developed a model of viral rhinosinusitis using intranasal inoculation of reovirus into mice that were then killed on postinoculation days 2, 4, 7, 10, 14, or 21 and heads were embedded in paraffin for histological and immunohistochemical analyses. Reovirus-like immunoreactivity was noted in the septa and paranasal sinus mucosa in mice as early as day 2, with peak intensity seen on day 4, and scant staining seen on day 7. Complete absence of viral staining was seen by day 10, which corresponded with increased intracellular adhesion molecule 1 immunostaining in the nose. By day 10, a large mucosal influx of B cells was observed, with a moderate influx of macrophages and smaller influx of T cells. By day 14, there was a peak in the number of B cells with a corresponding, but less pronounced peak in T cells, while macrophages began to decline at this point. By day 21, the panel of immune markers returned to near normal levels. The results of this study suggest that the immune system continues to produce a response as long as 2 weeks after clearance of viral antigens. One proposed mechanism for this phenomenon is that local factors such as cytokines are released continually after infection, even in the absence of persistent viruses or bacteria.

Animals↗
PubMedDate not supplied

Endoscopic sinus surgery in geriatric population.

BACKGROUND: With the baby boomers getting older, endoscopic sinus surgery (ESS) is being performed more on elderly people than before. We compared patients undergoing ESS who were >65 years of age with those <65 years. MATERIALS AND METHODS: We reviewed our database of cases who had ESS between 1992 and 2002. Demographics and patient characteristics and complications encountered intraoperatively and immediately postoperatively were reviewed. RESULTS: Forty-six (8.1%) patients were older than 65 years of age compared with 522 patients who were 18-64 years old. The older group had a 24% revision rate compared with 34% in the younger group. Complication rates were 21.7% for the elderly compared with 12.8% for the younger group. There was a significantly higher complication rate in the older group of people who were having revision ESS. CONCLUSION: The elderly people who were having revision surgery had a higher risk for complications compared with those having primary surgery or those <65 years old.

Adult↗