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PubMed1980

[Sinus arrhythmia: quantitative evaluation and possible use in the diagnosis of sick sinus syndrome (author's transl)].

This research was done in order to quantify the sinus arrhythmia and to determine any possible quantitative difference between normal subjects and patients with Sick Sinus Syndrome (SSS). The ECG of 200 normal subjects and 30 patients with SSS diagnosed with electrophysiologic evaluation have been studied. 50 consecutive PP intervals have been measured in each ECG, and the average and standard deviation (SD) were calculated. The variableness of the sinus cycle was expressed by the Sinus Arrhythmia Index (SAI), obtained by the ratio between the SD and the average length of the cycle. It was observed that in normal subjects the SAI decreases with aging, and its value is not related to the heart rate. The SAI was significantly higher in the patients with SSS than in the normal ones. Since a sinus arrhythmia of high degree may be observed in the SSS, the quantitative evaluation of this arrhythmia, obtained by the index we proposed, may be useful to the detection of this syndrome.

Aged↗
PubMed1995

[Endoscopic sinus surgery for chronic sinusitis in children].

Anatomical features show maxillary sinus to be most commonly involved during childhood chronic sinusitis. Fifty-one cases who failed to respond to medications and irrigation were selected to undergo the middle meatal antrostomy under endoscopy. The majority of them had maxillary sinusitis. 10 cases had middle turbinate edema and polyps. 6 had ethmoiditis. After operations, signs of headache eliminated in 20 cases, nasal obstruction in 43 cases and yellowish discharge in 37 cases. The operative results were satisfactory. It is demonstrated that endoscopic sinus surgery is an ideal therapy for the treatment of childhood chronic maxillary sinusitis at present.

Adolescent↗
PubMed1997

[20-year experience in obliteration of the frontal sinuses with formalinized allobrephobone in chronic frontal sinusitis].

Outcomes of surgical treatment of chronic recurrent frontal sinusis (FS) using obliteration of the frontal sinuses with allobrephobone in 228 patients (190 males and 38 females aged 15-71 years) are presented. 45 of them had undergone surgery on the frontal sinuses with reestablishment of the frontonasal shunt. Obliteration consists in removal granulations and polyps from the frontal sinus through the anterior wall followed by sinus mucosa scraching and the sinus separation from the nasal cavity with filling with small pieces of formalized allobrephobone. The technique is simple, postoperative period usually uneventful.

Adolescent↗
PubMed2000

Outcome analysis of endoscopic sinus surgery for chronic sinusitis in patients having Samter's triad.

A study was conducted to assess outcome analysis in acetylsalicylic acid (ASA) triad patients after endoscopic sinus surgery (ESS). The control group consisted of patients with chronic sinusitis, with or without asthma, who had also undergone ESS. The study group contained 18 patients with the classic triad who were compared with 22 controls. The study was conducted in retrospective fashion highlighting clinical presentation, radiologic evaluation, surgical findings, and recurrence rate of nasal polyps. Although both groups had a relatively similar age of onset of symptoms, the symptomatic picture was different in the two groups. Radiologic evaluation of the nose and paranasal sinuses revealed more extensive involvement of the sinuses in ASA triad patients. Furthermore, ASA triad patients underwent a greater number of repeat operations. This review suggests that ASA triad patients respond less well to surgical intervention and that other treatment modalities should perhaps be explored.

Adult↗
PubMed1994

Modern imaging of paranasal sinuses and the role of limited sinus computerized tomography; considerations of time, cost and radiation.

The modern diagnostic radiology department is equipped with a variety of medical imaging systems that can be used for evaluation of diseases of the sinonasal cavities. Each has advantages and disadvantages. The imaging examinations of the paranasal sinuses may include conventional films, complex motion tomography, computed tomography (CT) and magnetic resonance imaging (MRI). The indications for these imaging methods are reviewed, along with a discussion on the role of imaging for endoscopic sinus surgery. A summary of CT anatomy relating to the ethmoidal sinuses and ostiomeatal complex is given, as is a review of the risk of radiation for radiologic sinus imaging.

Carcinoma↗
PubMed2006

Bacteriology of chronic sinusitis and acute exacerbation of chronic sinusitis.

OBJECTIVE: To establish the microbiological characteristics of acute exacerbation of chronic sinusitis (AECS). SETTING: Academic medical center. PATIENTS: Thirty-two patients with chronic sinusitis and 30 patients with AECS. MAIN OUTCOME MEASURE: The aerobic and anaerobic microbiology of maxillary AECS and chronic maxillary sinusitis. RESULTS: A total of 81 isolates (33 aerobic and 48 anaerobic) were recovered from the 32 cases (2.5 per specimen) with chronic sinusitis. Aerobes alone were recovered in 8 specimens (25%), anaerobes only were isolated in 11 (34%), and mixed aerobes and anaerobes were recovered in 13 (41%). The predominant aerobic and facultative bacteria were Enterobacteriaceae and Staphylococcus aureus. The predominant anaerobic bacteria were Peptostreptococcus subspecies, Fusobacterium subspecies, anaerobic gram-negative bacilli, and Propionibacterium acnes. Twenty-one beta-lactamase-producing bacteria were recovered from 17 specimens (53%). A total of 89 isolates (40 aerobic and facultatives, and 49 anaerobic) were recovered from the 30 patients (3.0 per specimen) with AECS. Aerobes were recovered in 8 instances (27%), anaerobes only in 11 (37%), and mixed aerobes and anaerobes were recovered in 11 (37%). The predominant aerobes were Streptococcus pneumoniae, Enterobacteriaceae, and S aureus. The predominant anaerobes were Peptostreptococcus subspecies, Fusobacterium subspecies, anaerobic gram-negative bacilli, and P acnes. Thirty-six beta-lactamase-producing bacteria were recovered from 28 specimens (53%). CONCLUSIONS: This study demonstrates that the organisms isolated from patients with AECS were predominantly anaerobic and were similar to those generally recovered in patients with chronic sinusitis. However, aerobic bacteria that are usually found in acute infections (eg, S pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) can also emerge in some of the episodes of AECS.

Acute Disease↗
PubMed2006

Ruptured sinus valsalva aneurysm originating from the left coronary sinus: report of a rare case with computed tomography findings.

Sinus valsalva aneurysm is a rare condition. Most aneurysms usually originate from the right or non-coronary sinus. A few series were reported about the sinus valsalva aneurysm describing its origin, diagnostic tools and prognosis. We describe a case of a sinus valsalva aneurysm originating from the left coronary sinus that ruptured into the right atrium, diagnosed with echocardiography and cardiac computed tomography, confirmed by angiography and operational findings.

Adult↗
PubMed1982

Assessment of oral quinidine effects on sinus node function in sick sinus syndrome patients.

The effects of therapeutic doses of orally administered quinidine sulfate on sinus rhythmicity and automaticity were observed in 11 patients with sick sinus syndrome (SSS). Evaluation of sinus node (SN) function was undertaken by assessing sinus nodal recovery time (SNRT), treadmill exercise testing, and 24-hour ambulatory ECG monitoring before and after quinidine administration (25 mg/kg) (range 800 to 1600 mg daily). Corrected SNRT ranged from 100 to 1320 msec (average 551) before quinidine and was not significantly (p greater than 0.05) altered after quinidine to 346 to 660 msec (average 481). Further, quinidine did not induce accelerated infrasinus pacemaker activity. Spontaneous sinus rate evaluated with ambulatory monitoring revealed average rate of 57 bpm (range 53 to 63) before quinidine without significant increase to average 59 bpm (range 52 to 80) after quinidine therapy. Similarly, the maximal SN response to exercise was not significantly affected by quinidine (average 129 bpm before and 129 bpm after drug therapy). It is concluded that therapeutic doses of quinidine do not exert adverse effects on SN function in SSS patients. Chronic oral quinidine therapy can therefore be used safely with caution in patients with chronic SN disease when indicated for control of tachyarrhythmias.

Administration, Oral↗
PubMed1996

If functional sinus surgery fails: a radical approach to sinus surgery.

Radical surgery of the nose and paranasal sinuses was performed in 56 patients as a last resort for severe recurrent treatment-resistant rhinosinusitis. Surgery consists of removal of all walls between the nasal fossa and the paranasal sinuses, creating one cavity. All patients were permanently relieved of sinusitis and nasal obstruction, and other symptoms were greatly reduced. Morbidity is low in relation to preoperative symptoms. We conclude that radical sinus surgery is an effective last resort if functional sinus surgery repeatedly falls.

Adult↗
PubMedDate not supplied

Nontraumatic prolapse of the orbital contents into the ethmoid sinus: evaluation with screening sinus CT.

PURPOSE: The purpose of this study is to evaluate the incidence and CT features of nontraumatic prolapse of the orbital content into the ethmoid sinus, which may be a cause of orbital complication of ethmoidectomy. MATERIALS AND METHODS: CT of 1,024 consecutive patients with subjective sinonasal symptoms who underwent screening sinus CT were reviewed and analyzed. The 573 men and 451 women were between the ages of 5 and 79 years old. The patients with a history of sinus surgery of facial trauma were excluded from this study. The incidence and CT features of dehiscence and/or bowing of the lamina papyracea with prolapse of the orbital content in each age group and differences between the age groups were analyzed. RESULTS: Ethmoidal prolapse of the orbital content was found in 67 patients (6.5%). There was a tendency of increasing incidence with increasing age. The incidence in the juvenile age group was significantly low (1.9%) as compared with that of adult. Four patients (0.4%) had bilateral lesions. Twenty-nine lesions showed prolapse of moderate to severe degree, and deformity of the medial rectus muscle on coronal CT image was associated in 21 lesions. Inflammatory change of adjacent ethmoid sinus was indicated in 19 lesions, and there was no statistical difference in incidence from that of the opposite side. CONCLUSIONS: The incidence of nontraumatic prolapse of the orbital content is far beyond general expectations, and detailed structural information with CT for this anatomic alteration may be important before endoscopic sinus surgery to avoid possible complication. The higher incidence in adult may suggest age-related acquired etiologic factors besides congenital dehiscence or weakness of the lamina papyracea.

Adolescent↗
PubMed2000

Sparfloxacin for the treatment of acute bacterial maxillary sinusitis documented by sinus puncture.

PURPOSE: To evaluate the efficacy and safety of sparfloxacin in the treatment of patients with acute bacterial maxillary sinusitis, the microbiologic etiology of which was determined by maxillary sinus puncture. PATIENTS AND METHODS: Two hundred fifty-three patients enrolled in the open, noncomparative trial received sparfloxacin as a 400-mg loading dose followed by 200 mg once daily doses for a total of 10 days. One hundred ninety-eight patients were clinically evaluable and 82 were also bacteriologically evaluable. All treated patients were included in the safety analysis. Overall success was determined based on clinical success (resolution or reduction of signs and symptoms and sinus x-rays) and bacteriologic success (eradication and presumed eradication of baseline pathogens obtained by maxillary sinus puncture and aspiration). RESULTS: Overall success in the bacteriologically evaluable population at test-of-cure was 91.5% [75/82; 95% confidence interval (85.4%, 97.5%)]. For all pathogens, the eradication rate was 93.2% (109/117 baseline pathogens); individual pathogen eradication rates were 88.9% (16/18) for S. pneumoniae (including those strains exhibiting decreased susceptibility to penicillin); and 100% for H. influenzae (17/17), S. aureus (14/14), and M. catarrhalis (11/11). The majority of adverse events were of mild or moderate severity; the most frequently related adverse events were photosensitivity reaction, headache, nausea, and diarrhea. CONCLUSION: Sparfloxacin had an overall success rate of 91.5% for patients in this study and was generally well tolerated in the treatment of acute bacterial maxillary sinusitis.

Acute Disease↗
PubMed2003

Widely invasive solitary fibrous tumor of the sphenoid sinus, cavernous sinus, and pituitary fossa.

Solitary fibrous tumor is a spindle cell tumor first described in the pleura, but also found in multiple extrathoracic sites including the meninges, orbit, nasal and paranasal sinuses. No cases have been previously reported in the cavernous sinus or pituitary fossa. We present the case of a 54-year-old woman who presented with progressive amaurosis. On imaging studies, a widely infiltrative lesion involving the pituitary fossa, sphenoid sinus, cavernous sinus, carotid artery, medial temporal, ethmoid, and pterygoid bones, and extending into the nasopharynx was discovered; impression was a malignant tumor originating in the pituitary fossa. At surgery, the tumor was only partially resectable because of extensive bony invasion and encasement of the carotid artery, and was found to compress but not invade the pituitary gland. Histology showed a spindle cell proliferation with a dense, hyalinized collagenous stroma and dilated vascular spaces, some showing a staghorn-like appearance. Areas of cellular pleomorphism and increased cellularity were present, but few mitoses were identified. Immunohistochemistry showed strong positivity with CD34, factor XIIIa, CD99, and Bcl-2. There was scattered cyclin D1, mib-1, and p53 positivity. Muscle, epithelial, vascular, and melanocytic markers were negative. These results led to the diagnosis of solitary fibrous tumor. The size, extensive invasion, and bony destruction indicated a tumor with at least low malignant potential. The occurrence of solitary fibrous tumors in the pituitary fossa and sinuses of the head and neck is rare, but must be considered in the differential diagnosis of spindle cell lesions in these regions.

Biomarkers, Tumor↗
PubMed1997

Virtual endoscopy of the paranasal sinuses using perspective volume rendered helical sinus computed tomography.

Our goal was to use three-dimensional information obtained from helical computed tomographic (CT) data to explore and evaluate the nasal cavity, nasopharynx, and paranasal sinuses by simulated virtual endoscopy (VE). This was done by utilizing a new image reconstruction method known as perspective volume rendering (PVR). Thin-section helical CT of the nasal cavity, nasopharynx, and paranasal sinuses was performed on a conventional CT scanner. The data were transferred to a workstation to create views similar to those seen with endoscopy. Additional views not normally accessible by conventional endoscopy were generated. Key perspectives were selected, and a video "flight" model was choreographed and synthesized through the nasal cavity and sinuses based on the CT data. VE allows evaluation of the nasal cavity, nasopharynx, and paranasal sinuses with appreciation of the relationships of these spatially complex structures. In addition, this technique allows structural visualization with unconventional angles, perspectives, and locations not conventionally accessible. Although biopsies, cultures, and lavages routinely done with endoscopy cannot be performed with VE, this technique holds promise for improving the diagnostic evaluation of the nasal cavity, the nasopharynx, and the paranasal sinuses. The unconventional visual perspectives and very low morbidity may complement many applications of simple diagnostic endoscopy.

Endoscopy↗
PubMed2005

Nosocomial sinusitis: a unique subset of sinusitis.

PURPOSE OF REVIEW: Nosocomial sinusitis is a complication of critically ill patients that is frequently not considered as a cause of fever and infection. While this disease has been described in the literature there have been few recent citations on this subject. This brief review will familiarize the reader with the current state of the art with regard to diagnosis complications and treatment of this problem. RECENT FINDINGS: Nasal and oral tubes have been the prime inciting events. Other risk factors have been facial trauma, inability to mobilize the patient and prior sinus disease. Patients usually present while in the intensive care unit; and there are few signs that suggest sinusitis to the critical care team. A number of complications including direct extension to the brain, lung and blood stream, as well as sepsis and even death have been described. The diagnosis is usually made with the help of specific radiographs or computed tomography scans when these modalities are used. The microbiology is quite different than sinusitis in the community. Staphylococcus spp., Pseudomonas spp. and other nosocomial organisms are frequently isolated when specific cultures are obtained. Treatment usually consists of removal of the tubes mobilizing the patient and institution of broad-spectrum antibiotics aimed at the offending organisms. SUMMARY: Nosocomial sinusitis continues to be a major problem causing morbidity and occasionally mortality in critically ill patients. Recent findings have suggested that a careful search for this disease and appropriate treatment if found can decrease both morbidity, mortality and subsequent other nosocomial infections.

Cross Infection↗
PubMed2005

Microbiology of sinusitis and the predictive value of throat culture for the aetiology of sinusitis.

A prospective study of throat cultures and maxillary sinus aspirates from children with chronic sinusitis (n = 21), acute sinusitis (n = 28) or a clinical diagnosis of chronic adenoiditis (n = 41) was performed. Seventy-two bacterial pathogens were isolated from sinus aspirates from 52% of the study population. Haemophilus influenzae was most common pathogen, followed by Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and group A streptococci. Quantitative throat cultures had positive predictive values of 41%, 53% and 75% for H. influenzae, Strep. pneumoniae and M. catarrhalis, respectively, while negative predictive values were 93-98%, indicating that these three pathogens do not cause sinusitis when absent from the throat.

Adenoids↗
PubMed1986

Antibodies to human sinus node in sick sinus syndrome.

The incidence of autoantibodies against human conducting tissue was studied in 45 pacemaker patients with sick sinus syndrome (SSS), in 17 patients with bradyarrhythmia, and five patients with hypersensitive carotid sinus syndrome. Antibodies against the human sinus node were demonstrated in 29% of patients with SSS and in 24% of patients with bradyarrhythmia; a tenfold risk of SSS could be calculated in patients with this antibody as compared to age-matched controls. At least two subtypes of anti-sinus node antibodies were demonstrated: an antibody absorbable and another one not absorbable with ventricular myocardium. Patients with SSS and prior myocarditis of rheumatic fever have a threefold incidence of that antibody, demonstrating that anti-conducting tissue antibodies are etiologic indicators for former inflammatory heart disease. These antibodies may play a role in the secondary immunopathogenesis of sick sinus syndrome. This hypothesis emerges as an interesting new pathogenetic concept.

Aged↗
PubMed1989

Cough syncope caused by sinus arrest in a patient with sick sinus syndrome.

Cough syncope is a syndrome in which dizziness or syncope occurs after prolonged bouts of cough. This paper presents a case of 63-year-old man with recurrent dizziness and syncope. The 24-hour ambulatory electrocardiogram and intracardiac electrogram showed sinus node dysfunction with sinus arrest, both spontaneous and inducible by voluntary cough. Sinus arrest was sometimes associated with dizziness. A permanent VVI pacemaker was implanted and no further cough syncope has occurred. We suggest that sinus arrest may play a role as a mechanism of cough syncope in a patient with sick sinus syndrome.

Cough↗
PubMed2000

[Study on endoscopic sinus surgery management of chronic sinusitis with nasal polyps].

Endoscopic sinus surgery is commonly used to treat chronic sinusitis. Subjects were 79 chronic sinusitis patients--50 men and 29 women aged 17 to 79 years (average: 50.6 years) undergoing endoscopic sinus surgery in our department from January 1993 to December 1997. Mean follow-up was 17.5 months. We evaluated preoperative staging of chronic sinusitis based on Kennedy staging. Most were stage 3. This type of staging was not effective in predicting nasal polyp relapse. We found that cases with diffuse polyposis and associated disease such as bronchial asthma or aspirin-induced asthma tended to experience a polyp relapse. Our results suggest that postoperative treatment is important in maintaining patency of the ostiomeatal complex, nasal polyp or edematous mucosa relapse must be treated early in on in occurrence.

Adolescent↗