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PubMedDate not supplied

[Sinus-catheter "Iamik" in the treatment of combined forms of acute suppurative sinusitis].

The efficacy of "YAMIK" sinus catheter versus conventional sinus punctures has been tried in acute purulent polysinusitis. "YAMIK" provides atraumatic evacuation of the discharge from all the sinuses on one side as well as introduction of the drugs into the sinuses via natural shunts by means of controlled intermittent pressure produced in the nasal cavity and paranasal sinuses. The methods was tested in 101 patients with acute purulent polysinusitis versus punctures of the maxillary and frontal sinuses in 30 controls. The differences in the outcomes were insignificant, through the catheter has the advantage of more rapid sinus cleansing. The authors recommend the above catheterization as pathogenetic, usable in inpatient and outpatient settings.

Acute Disease↗
PubMed1993

[Incidence of weak sinus syndrome in patients with sinus bradycardia and prognosis].

A total of 270 patients with sinus bradycardia were studied to detect the sick sinus syndrome (SSS) in them and to determine the impact of sex, age, heart rate and atropine test on sinus function recovery time (SFRT) and corrected sinus function recovery time (CSFRT). The study indicated that CSFRT which is pathological at a duration of 525 msec or more was most valuable in the diagnosis of the sick sinus syndrome. Responses to atropine tests were significantly different in healthy persons and in patients with lower automatic sinus function. Increases in heart rate during the atropine test by less than 70% of the baseline suggests an organically decreased automatic function. In patients with sinus bradycardia, the age was related to SFRT to a lesser extent, when the baseline heart rate only in males affected SFRT rather than CSFRT. After atropine administration and its percentage increase, heart rate was found to be closely related to SFRT and CSFRT.

Adolescent↗
PubMed1977

[Hypersensitive carotid sinus reflex in older patients. Incidence and significance for the diagnosis of sick sinus node].

Carotid sinus massage was performed in 100 consecutive patients over the age of 50 years: 63 showed a normal reaction and sinus bradycardia occurred in 12, whereas sinus arrest was registered in 22 and total AV block in 3. With atrial pacing only 2 patients with sick sinus syndrome could be detected. Intravenous administration of atropine did not help to identify them. We conclude that in 1/4 to 1/3 of these elderly people the sinus node reacts in a hypersensitive manner to carotid sinus massage, but this does not imply the diagnosis of sick sinus syndrome.

Aged↗
PubMed1998

One-year outcome analysis of functional endoscopic sinus surgery for chronic sinusitis.

OBJECTIVE: This study was conducted to assess treatment results in patients undergoing functional endoscopic sinus surgery for chronic sinusitis, with evaluation of prognostic indicators of success and failure. METHOD: The study included 393 patients who underwent endoscopic sinus surgery for chronic sinusitis over a 4-year period. The diagnosis of chronic sinusitis was based on ongoing symptomatology for greater than 3 months and the presence of mucosal disease on computerized tomography (CT). A retrospective analysis was done looking at patient data, presenting symptoms, CT findings, operative reports, pathology reports, and outcome at 6- and 12-month follow-up. The prognostic significance of selected factors was evaluated using chi-square analysis. RESULTS: A positive history for asthma, allergy, and ASA triad was present in 29.5%, 34.6%, and 10.9% of patients, respectively. Previous sinus surgery was done in 31.9%, and 15.7% of patients were smokers. The most common presenting complaint was nasal congestion/obstruction, followed by facial pain/headaches and olfactory disturbance. A positive outcome was achieved in 80.5% of patients at 6 months and in 69.7% at 12-month follow-up. Revision surgery within a year was needed in 4.1% of patients. Factors affecting outcome included asthma, smoking, polyposis, previous surgery, and pansinusitis. CONCLUSIONS: Extent of disease, as reflected by polyposis, pansinusitis, and premorbid history, is the most important determinant of outcome. Concomitant changes in ciliary motility secondary to asthma or smoking further impede surgical outcome. Future studies focusing on the disease process of chronic sinusitis are needed.

Adolescent↗
PubMed2000

Do maxillary sinus retention cysts reflect obstructive sinus phenomena?

OBJECTIVE: To determine the relation of maxillary sinus retention cysts (RCs) to ostiomeatal complex (OMC) obstruction and anatomic variation of the paranasal sinuses. METHODS: The results of 410 computed tomographic scans of the sinuses ordered by otolaryngologists in an academic center during a 1-year period were reviewed. Computed tomographic scans with maxillary sinus RCs were studied to determine cyst characteristics, the Lund score, OMC size and patency, and the presence of anatomic variations. Statistical analysis was conducted to determine the relation of RCs to these factors. RESULTS: The incidence of RCs was 12.4% (51 cases). The mean patient age was 41.3 years, with a female-male ratio of 2.4:1. Nine cases demonstrated bilateral cysts, allowing 42 unilateral cases to be analyzed with the nondiseased side as a control. The mean cyst size was 1.56 cm, and cysts were most commonly located inferiorly (30 [50%]) and were solitary (45 [88%]). The RC side had a higher mean Lund score than the control side (2.62 vs 1.93; P =. 008, Wilcoxon signed rank test). Of the cyst sides, 18 (43%) demonstrated OMC occlusion, vs 15 (36%) for the control side (P =.55, McNemar test). The mean OMC size was smaller for the cyst side vs the control side (0.77 vs 1.35 mm; P =.13). No association was found between RCs and concha bullosa or Haller cells (P =.45 and P =.39, respectively). CONCLUSIONS: Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC, and are not associated with potentially obstructive anatomic sinus variations. Consideration should be given to not scoring RCs as positive disease during Lund staging.

Adult↗
PubMedDate not supplied

Paranasal sinus radiology, Part 2A: Ethmoidal sinuses.

The clinician must have a high level of suspicion in order to detect ethmoidal sinus disease. Survey plain film radiographic examination may provide information about gross changes in ethmoidal sinus transparency and the sinus walls. Conventional tomographic study will often aid evaluation of the ethmoidal sinus walls which may be obscured by overlying structures on plain films. Computerized tomography adds a new dimension to ethmoidal sinus study. By revealing not only bone changes but soft-tissue abnormality as well, more complete understanding of the disease process is gained. Computerized tomography is particularly useful in evaluating orbital structural change due to ethmoidal sinus abnormality

Ethmoid Sinus↗
PubMed1986

Nasal and paranasal sinus endoscopy. A diagnostic and surgical approach to recurrent sinusitis.

Our endoscopic concept of the diagnosis and surgical treatment of recurrent sinusitis is based on Messerklinger's finding that almost all infections of the frontal and maxillary sinuses are rhinogenic. They are secondary to infection foci in their prechambers in the anterior ethmoid, especially in the ethmoidal infundibulum and the frontal recess, spreading from there to the dependent larger sinuses. Consequently, our functional endoscopic sinus surgery is aimed at these infection foci in the ethmoid, clearing mucosal contact areas, stenotic clefts and diseased cells. Ventilation and drainage of frontal and maxillary sinuses are re-established via their natural routes. There is no need for fenestration via the inferior meatus. Disease in the larger sinuses then usually heals without the mucosa having actually been touched. In our experience, this leaves hardly any indication for external or more radical procedures. The technique of endoscopic diagnosis and surgery are described in detail.

Endoscopy↗
PubMed1995

Percutaneous endoscopic sinus surgery for frontal sinusitis or a cyst.

Using percutaneous endoscopic surgery, we achieved good results in patients with frontal sinus cyst. The surgical procedure is described and discussed. The endoscopic system consisted of a needle-shaped rigid fiberscope (direct-vision and angle-vision types [30 degrees, 90 degrees]) 1.7 mm in diameter with a light source. A small incision was made at the eyebrow, the sinus was cleaned, and an opposite hole was made through the existing wound. This procedure permitted less invasive surgery under direct view of the surgical field compared with conventional percutaneous transnasal frontal sinus procedures. Postoperative patency of the sinus was also satisfactory. This percutaneous endoscopic procedure was designed for surgical maneuvers in the frontal sinus through a small, 3- to 5-mm incision. This technique is considered effective for the treatment of inflammatory disorders of the frontal sinus caused by positional abnormalities after trauma or recurrence after conservative transnasal surgery.

Adult↗
PubMed2000

Bacteriology of nontraumatic maxillary sinus mucoceles versus chronic sinusitis.

OBJECTIVE: To compare the bacteriology of maxillary sinus mucoceles to chronic sinusitis and understand the pathogenesis of nontraumatic maxillary sinus mucoceles (NTMSM). STUDY DESIGN: Retrospective review. METHODS: Review of intraoperative bacteriology culture results obtained in patients with NTMSM. Patients with history of facial trauma or previous paranasal sinus surgery were not included in the study. The results were compared to intraoperative cultures obtained from patients with chronic sinusitis (CS). RESULTS: The study groups consisted of 16 patients with NTMSM (9 male and 7 female patients) and 211 patients with CS (86 male and 125 female patients). Cultures in the NTMSM group were positive in 7 of 16 patients (44%) (four cultures had more than one isolate). There was no growth in cultures of 9 patients (56%). On the other hand, cultures in 176 patients with CS (83%) grew organisms (42 cultures had more than one isolate); there was no growth in 35 of 211 patients (17%) (P = .0007). The cultures grew aerobic bacteria in 7 of 16 (44%) and 160 of 211 (76%) patients of the NTMSM and CS groups, respectively. Anaerobic bacteria were detected in cultures of 2 of 16 patients (12.5%) with NTMSM compared with 13 of 211 patients (6.2%) in the CS group (P = .286). The most common pathogenic aerobe in the NTMSM group was alpha-hemolytic Streptococcus, while Staphylococcus aureus was the most common in the CS group. CONCLUSION: The bacteriology of maxillary sinus mucoceles is different from that of CS. The majority of patients with mucoceles have sterile intraoperative cultures. The data do not support infection as the main origin of NTMSM.

Adult↗
PubMed2003

Conventional sinus radiography compared with CT in the diagnosis of acute sinusitis.

OBJECTIVES: To evaluate the value of plain film radiography in a prospective investigation of patients with clinical suspicion of acute sinusitis, using standard CT as a gold standard. METHODS: 47 consecutive patients were examined. Each patient underwent conventional X-ray and standard dose CT examinations on the same day. The sensitivity and specificity of the plain film examination were calculated. RESULTS: The specificity of the plain film examination was high, but the sensitivity was low except for the maxillary sinus (sensitivity 80%). Thus, for maxillary sinusitis, plain film examination was reasonably accurate. A negative finding in the other sinuses could not be relied upon. CONCLUSIONS: The sensitivity of plain film radiography for detecting sinus opacifications was unacceptably low for the ethmoid, frontal and sphenoid sinuses. The specificity was high.

Adolescent↗
PubMed2000

Gamma knife radiosurgery as a primary treatment for prolactinomas.

OBJECT: The purpose of this study was to estimate the efficacy of gamma knife radiosurgery (GKS) in controlling tumor growth and endocrinopathy associated with prolactinomas. METHODS: Between 1993 and 1997, 164 of 469 patients with pituitary adenomas treated by GKS harbored prolactinomas. The dose to the tumor margin ranged from 9 to 35 Gy (mean 31.2 Gy), and the visual pathways were exposed to a dose of less than 10 Gy. The mean tumor diameter was 13.4 mm. The mean follow-up time for 128 cases was 33.2 months (range 6-72 months). Tumor control was observed in all but two patients who underwent surgery 18 and 36 months, respectively, after GKS. Clinical cure was achieved in 67 cases. Clinical improvement was noted with a decrease in the hyperprolactinemia after GKS. Nonetheless, in 31 (29%) of 108 patients who were followed for more than 2 years no improvement in serum prolactin levels was demonstrated, although this could be normalized by bromocriptine administration after treatment. Nine infertile women became pregnant 2 to 13 months after GKS and all gave birth to normal children. There was no visual deterioration related to GKS. Five women experienced premature menopause. In these patients there was subtotal disappearance of the tumor and an empty sella developed. CONCLUSIONS: Gamma knife radiosurgery as a primary treatment for prolactinomas can be safe and effective both for controlling tumor growth and for normalization of prolactin hypersecretion. A higher margin dose (> or = 30 Gy) seemed to be associated with a better clinical outcome. Gamma knife radiosurgery may make prolactinomas more sensitive to the bromocriptine.

Humans↗
PubMed1995

Evaluation of endoscopic sinus surgery for chronic sinusitis: post-operative erythromycin therapy.

We discuss the results of endoscopic endonasal sinus surgery for chronic pan-sinusitis characterized by nasal polyposis, especially the effects of post-operative long-term administration of low-dose erythromycin (EM) therapy. The subjects analysed in this retrospective study are surgical cases who had initially been operated for chronic pan-sinusitis. They are classified into one group who has received a post-operative long-term, low-dose EM regimen and into another group who has not received this treatment. The groups have been compared with respect to: (1) the degree of improvement in the post-operative subjective symptoms; (2) postoperative objective findings of the ethmoidal sinus and the ostium of the frontal sinus; and (3) the degree of improvement in the maxillary sinus lesion. Better improvement is achieved in subjective symptoms and objective findings in the EM group than in the non-EM group.

Adolescent↗
PubMed1997

Blood vessels of the sinus tarsi and the sinus tarsi syndrome.

This study describes the arterial and venous blood vessels in the sinus tarsi of a series of nine anatomical specimens and in a traumatically amputated leg, studied by arteriography. The sinus tarsi artery was formed in all cases from anastomoses between various arteries of the lateral region of the foot. These usually included the anterior lateral malleolar, and proximal lateral tarsal arteries; in 70% there was a branch from the distal lateral tarsal artery, and in 30% a branch from the peroneal artery. In all cases, there were anastomoses within the sinus tarsi between the sinus tarsi artery and the canalis tarsi artery, derived from the posterior tibial artery. Whatever its origins, the sinus tarsi artery was the principal supplier of intrasinusal structures and of the talus. There was a large venous plexus in the sinus tarsi, which drained particularly the venous outflow from the talus and the anterior part of the capsule of the posterior talocalcaneal joint to the lateral and medial venous systems of the foot. Posttraumatic fibrotic changes in the wall and surrounding tissue of the veins, causing disturbance of venous outflow and increased intrasinusal pressure, are proposed by the authors as one possible factor in the pathogenesis of the sinus tarsi syndrome.

Arteries↗
PubMed1975

Sinus nodal responses to atrial extrastimuli in patients without apparent sinus node disease.

In 36 patients without sinus node disease scanning with an atrial extrastimulus (A2) was performed during sinus rhythm with the sinus cycle length measured in milliseconds. Zones of nonreset due to interference, reset, interpolation and sinus echoes were defined by noting the timing of the first response after A2. Zones were defined in terms of their longest and shortest A1-A2 coupling intervals (in milliseconds). A zone of nonreset was found in 12 of 12 patients in whom A2 was delivered late. The mean cycle length in these 12 patients was 779 msec, with a mean zone of nonreset of 779 to 585 msec (25 percent of cycle length). All 36 patients (100 percent) had a zone of reset. The mean cycle length in these 36 patients was 803 msec with a zone of reset from 692 to 319 msec (46 percent of cycle length). Seven of 36 patients (19 percent) had a zone of interpolation. The mean cycle length in these seven patients was 754 msec, with a mean zone of interpolation of 344 to 279 (9 percent of cycle length). Four of 36 patients (11 percent) had a zone of sinus echoes. The mean cycle length in these four patients was 870 msec, with a mean zone of echoes from 350 to 313 msec (4 percent of cycle length). Calculated sinoatrial conduction time ranged from 40 to 153 msec (mean +/- standard deviation 92 +/- 30 msec). Shortening of the cycle length with atrial pacing increased the number of patients with zones of interpolation and echoes. In conclusion, zones of nonreset and reset are found in all patients with normal sinus nodal function, whereas zones of interpolation and echoes are much less common. Sinoatrial conduction time is surprisingly long in patients without apparent sinus node disease.

Adult↗
PubMed2001

Total urogenital sinus mobilization: a modified perineal approach for feminizing genitoplasty and urogenital sinus repair.

PURPOSE: We report a modification of the total urogenital sinus mobilization technique adapted to the repair of isolated persistent urogenital sinus and masculinized external female genitalia. MATERIALS AND METHODS: The records of 6 girls undergoing total urogenital sinus mobilization were reviewed. Diagnosis was the adrenogenital syndrome in 4 girls, and persistent urogenital sinus and true hermaphroditism in 1 girl each. Mean patient age at the time of surgery was 5.9 years (range 4.5 months to 19.5 years). The surgical technique was modified by using the perineal approach since all patients had normal anorectal anatomy. A posterior perineal skin flap was used to widen the vaginal introitus. The wall of the mobilized urogenital sinus was opened and used to create a mucous lined vestibule. In those cases of the adrenogenital syndrome reduction clitoroplasty was performed at the same time. Postoperative results were assessed subjectively by observation of the vulvar appearance and objectively by determining the location of the urethral meatus and caliber of the vagina. RESULTS: Mean followup was 3.7 months (range 1 to 9). There were no postoperative complications. Most patients were discharged home within 3 days of surgery. All patients have a satisfactory cosmetic appearance. The urethral meatus was situated in the vestibule and easily accessible. There were no changes in voiding habits postoperatively in those patients who were toilet trained before surgery. Vaginal calibration was performed in 4 patients and mean vaginal caliber was 10.5 Hegar (range 6 to 14). CONCLUSIONS: The repair of persistent urogenital sinus less than 3 cm. long can be accomplished with total urogenital sinus mobilization through the perineal approach. The technique can be combined with reduction clitoroplasty for the surgical management of girls with masculinized external genitalia.

Adolescent↗
PubMed1994

Electrophysiological testing of sinus node function: diagnostic and prognostic application-including updated information from sinus node electrograms.

Sinus node function, including automaticity, conduction, and refractoriness, can be studied in the human electrophysiology laboratory. This review details the current methods used for such studies and discusses their clinical value. Of special emphasis in this article is the role of sinus node electrography in the clinical laboratory. Included also is an update of the data relating the duration of sinus node depolarization as measure on sinus node electrograms to other parameters that assess sinus node function as well as data supporting the direct relationship between the duration of the sinus node depolarization as the severity of sinus node dysfunction.

Action Potentials↗
PubMed2001

Tarsal sinus: arthrographic, MR imaging, MR arthrographic, and pathologic findings in cadavers and retrospective study data in patients with sinus tarsi syndrome.

PURPOSE: To evaluate the tarsal sinus by using different imaging techniques and specialized planes. MATERIALS AND METHODS: Magnetic resonance (MR) imaging of the tarsal sinus was performed in 10 cadavers. Conventional arthrography of the anterior and posterior subtalar joints was then performed. Tarsal sinus ligaments were evaluated further on initial and reconstructed MR arthrograms along and perpendicular to their axes. Pathologic correlation was performed in five specimens suspected of having tarsal sinus lesions on the basis of initial imaging findings. In 37 patients with a clinical diagnosis of sinus tarsi syndrome, MR images of the ankle were obtained before and after intravenous gadolinium-based contrast material administration and were reviewed to verify the integrity of the tarsal sinus ligaments. RESULTS: Two complete and three partial cervical ligament (CL) tears and one complete interosseous talocalcaneal ligament (ITCL) tear were diagnosed with MR imaging. Only one complete and one partial CL tear were seen after evaluation of both initial and reconstructed MR arthrograms and confirmed with pathologic correlation. In 18 patients, the diagnosis was confirmed at MR imaging, which depicted ITCL and CL tears in 11 patients, isolated CL tears in three patients, ganglia in three patients, and pigmented villonodular synovitis in one patient. CONCLUSION: Cadaveric study results indicate that initial and reconstructed MR arthrograms along and perpendicular to the ligament axes are potentially useful for further evaluation of individual tarsal sinus structures.

Adult↗
PubMed1999

[The histopathological observation and the clinical significance of invasion of pyriform sinus apex in pyriform sinus carcinoma].

OBJECTIVE: To approach the clinical significance of pyriform sinus carcinoma invading to pyriform sinus apex. METHOD: Forty-three cases of surgical specimens from total laryngectomy and partial hypopharyngectomy of pyriform sinus carcinoma were made with the organ subserial sectioning and pathological study. RESULT: Pyriform sinus apex is the inferior 1/3 region of pyriform sinus. If pyriform sinus carcinoma invades its apex, the cancerous tissue easely infiltrated the adjacent structure and organs. CONCLUSION: The invasion of pyriform sinus apex is the beginning position and the most important sign of invading downward the tissue and surrounding organs in the inferior position of hypopharynx. When surgery treatment is performed, the total laryngectomy and hypopharyngectomy of ill hypopharynx is appropriate and necessary.

Adult↗