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PubMed1991

Prolonged and fractionated right atrial electrograms during sinus rhythm in patients with paroxysmal atrial fibrillation and sick sinus node syndrome.

Intraatrial catheter mapping of the right atrium was performed during sinus rhythm in 92 patients: Group I = 43 control patients without paroxysmal atrial fibrillation or sick sinus node syndrome; Group II = 31 patients with paroxysmal atrial fibrillation but without sick sinus node syndrome; and Group III = 18 patients with both paroxysmal atrial fibrillation and sick sinus node syndrome. Atrial electrograms were recorded at 12 sites in the right atrium. The duration and number of fragmented deflections of the atrial electrograms were quantitatively measured. The mean duration and number of fragmented deflections of the 516 atrial electrograms in Group I were 74 +/- 11 ms and 3.9 +/- 1.3, respectively. The criteria for an abnormal atrial electrogram were defined as a duration of greater than or equal to 100 ms or eight or more fragmented deflections, or both. Abnormal atrial electrograms were observed in 10 patients (23.3%) in Group I, 21 patients (67.7%) in Group II and 15 patients (83.3%) in Group III (Group II versus Group I, p less than 0.001; Group III versus Group I, p less than 0.001). The mean number of abnormal electrograms per patient with an abnormal electrogram was 1.3 +/- 0.7 in Group I, 2.5 +/- 1.9 in Group II and 3.5 +/- 2.5 in Group III (Group I versus Group II, p less than 0.01; Group II versus Group III, p less than 0.05). A prolonged and fractionated atrial electrogram characteristic of paroxysmal atrial fibrillation can be closely related to the vulnerability of the atrial muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Infected dermoid sinus tract mimicking recurrent sinusitis in an adolescent male.

Nasal dermoid sinus cysts are the most common congenital midline nasofrontal masses, but they can easily be confused with simple recurrent sinusitis upon clinical presentation. We report the case of a 14-year-old male who was initially diagnosed with frontal sinusitis and treated with antibiotics but, after multiple episodes of recurrence, was later sent for imaging. Computed tomography and magnetic resonance imaging showed an infected dermoid sinus tract. Subsequent surgery removed the mass and pathologic investigation proved the diagnosis.

Adolescent↗
PubMed2002

One-year low-dose erythromycin treatment of persistent chronic sinusitis after sinus surgery: clinical outcome and effects on mucociliary parameters and nasal nitric oxide.

OBJECTIVE: In 17 patients with chronic sinusitis persistent after sinus surgery, long-term, low-dose erythromycin therapy was tested. The aim of the investigation was to study the clinical outcome and effects on nasal nitric oxide (NO), ciliary beat frequency (CBF), and mucociliary transport (saccharine transit time). STUDY DESIGN AND SETTING: We conducted a prospective open study at a tertiary teaching hospital. Symptoms were assessed using visual analog scales. NO was measured using a chemiluminescence analyzer, and mucociliary transport was measured with the saccharine crystal technique. CBF was measured in nasal brush samples using a phase contrast microscope. All patients were treated with erythromycin succinate 250 mg 2x daily or clarithromycin 250 mg 1x daily and were assessed after 3 months. In cases where there was no response, treatment was abandoned. The remaining patients (responders) were reassessed after 12 months of treatment. RESULTS: Of 17 patients, 12 responded to treatment. The 12-month follow-up showed an improvement in saccharine transit time (P < 0.05) but no significant change in CBF. There was a trend toward an increase in NO (P = 0.12). Endoscopic nasal examination scoring improved significantly (P < 0.01). In the visual analog scale scoring, the most pronounced improvements were seen in nasal congestion, sticky secretion, and runny nose at 3 and 12 months (P < 0.01). Improvements were also seen in headache (P < 0.05). CONCLUSION: The present study suggests that long-term, low-dose treatment with erythromycin is effective in persistent chronic sinusitis that does not respond to sinus surgery or systemic steroid/antibiotic treatment. SIGNIFICANCE: Long-term, low-dose erythromycin therapy seems to be a promising alternative when more conventional therapy fails. However, placebo-controlled studies are needed to validate the potential of this treatment.

Adolescent↗
PubMed2005

Arterial supply of maxillary sinus and potential for bleeding complication during lateral approach sinus elevation.

There are 3 arteries that supply the maxillary sinus (i.e., the posterior superior alveolar, infraorbital, and posterior lateral nasal arteries), any of which may be encountered during lateral approach sinus elevation surgery. These arteries are ultimate branches of the maxillary artery. Although it has not been reported, there is a theoretical potential for severing an intraosseously located artery during a vigorous curettage for sinus lining elevation in the posterior medial wall of the sinus. Techniques for cessation of bleeding are discussed, such as electrocautery and endoscopic ligation. Head elevation can significantly decrease blood flow to the area.

Arteries↗
PubMed2006

Tridimensional analysis of maxillary sinus anatomy related to sinus lift procedure.

PURPOSE: To evaluate the angulation of the maxillary sinus walls at the apical sinus region. MATERIALS AND METHODS: Using preoperative computerized tomographies of 15 patients selected for sinus lift procedures, the angulation of the maxillary sinus floor was measured drawing straight lines tangential to the mesial and lateral walls. The measurements were taken from sagittal images at specific areas (i.e., second bicuspid, first molar, and second molar). RESULTS: The results showed that the second bicuspid sites have a sharper angulation than the second molar sites, and these second molar sites have a sharper angle than the first molar sites. CONCLUSION: The sharper angle observed in the second bicuspid area can influence the feasibility of schneiderian membrane evaluation when compared to the molar areas.

Analysis of Variance↗
PubMed1994

Sinus node modification using radiofrequency current in a patient with persistent inappropriate sinus tachycardia.

Radiofrequency catheter modification of the sinus node for persistent inappropriate sinus tachycardia has not been previously reported. This article describes a patient in whom radiofrequency current was used to ablate an incessant automatic tachycardia focus mapped to the region of the sinus node, where a discrete multicomponent electrogram demonstrating earliest atrial activation was recorded. A transient junctional rhythm developed immediately after ablation, with rapid subsequent emergence of a stable rhythm having normal sinus nodal characteristics.

Adult↗
PubMed1999

Clinical update--the teeth and the maxillary sinus: the mutual impact of clinical procedures, disease conditions and their treatment implications. Part 2. Odontogenic sinus disease and elective clinical procedures involving the maxillary antrum: diagnosis and management.

Although odontogenic sinusitis is a rare entity when compared to sinus disease of rhinogenic origin, it is extremely important to identify a dental aetiology when it occurs. The offending tooth or teeth would thus require endodontic treatment or extraction, and the sinus disease carefully assessed and appropriately managed. Aetiology and presentation of oro-antral fistulae are also discussed and guidelines for the management of this complication are recommended. Certain lesions such as cysts and tumours may involve the jaws and hence the maxillary antrum; some of these, such as a radicular cyst are quite common, but the rarer ones are included for completeness. Surgical techniques are continuously evolving to optimise form and function of the jaws, and when applied to the maxilla there may be some impact on nasal and sinus function. The advent, and now proven success, of osseointegrated jaw implants have brought with them innovations and refinements of bone grafting techniques, and more recently distraction osteogenesis for augmentation. Maxillary osteotomies for surgical orthodontics, and to facilitate prosthodontic treatment are briefly mentioned, as most of these inevitably involve the antrum and/or nose. This paper discusses, in summary form, important aspects of clinical dental practice which may involve the maxillary antrum. It is thus a broad overview of certain pathologic conditions and elective surgical procedures which have relevance to both medical and dental practitioners.

Bone Transplantation↗
PubMed1982

Differential response to carotid sinus pressure during sinus rhythm and atrial fibrillation.

In a patient who presented with syncope and palpitation left carotid sinus massage resulted in prolonged ventricular asystole during atrial fibrillation. In the same patient left carotid sinus stimulation during sinus rhythm produced no change in sinus rate and only slight PR interval prolongation. This very different response may be the result of factors which are relevant only during atrial fibrillation such as an increase in the atrial depolarisation frequency and a prolongation of the duration of the atrioventricular nodal concealment zone secondary to increased vagal activity. An increase in atrioventricular nodal refractoriness could not explain this differential response.

Aged↗
PubMed2002

Mastoid air sinus abnormalities associated with lateral venous sinus thrombosis: cause or consequence?

BACKGROUND: Mastoiditis is a known cause of lateral venous sinus thrombosis (LST). We have encountered patients with LST associated with mastoid abnormality on MRI without any clinical signs of infection; the significance of these abnormalities is uncertain. This study examines the relationship of LST and mastoid air sinus abnormalities systematically. SUMMARY OF REPORT: We performed a retrospective clinical and radiological review of a series of 26 patients with cerebral venous thrombosis. Mastoid abnormalities were detected ipsilateral to 9 of 23 thrombosed lateral sinuses (39%) and 0 of 29 unaffected lateral sinuses (P<0.001). No patient had clinical evidence of mastoiditis. Eight of 9 patients with mastoid abnormalities were treated without antibiotics; all made uneventful clinical recoveries. Repeated MRI in 1 patient revealed reversal of the mastoid changes. CONCLUSIONS: The mastoid changes observed are likely to be due to venous congestion as a consequence of LST, not mastoiditis.

Adolescent↗
PubMed2001

Correlation between microbiology and previous sinus surgery in patients with chronic maxillary sinusitis.

Aspirates of 108 chronically inflamed maxillary sinuses were processed for aerobic and anaerobic bacteria. There were 295 bacterial isolates: 109 aerobic and facultative, and 186 anaerobic. The predominant aerobic isolates were Staphylococcus aureus (17 isolates), alpha-hemolytic streptococci (14), Pseudomonas aeruginosa (12), Moraxella catarrhalis (10), and Haemophilus spp (8). The predominant anaerobes were Peptostreptococcus spp (61), Prevotella spp (45), Fusobacterium spp (15), and Propionibacterium acnes (14). Analysis of the medical histories revealed a correlation only between the microbial results and previous sinus surgery. Pseudomonas aeruginosa and gram-negative aerobic bacilli (GNAB) were more often isolated in patients who had surgery (9 of 33 patients had P aeruginosa and 17 had GNAB) than in patients who did not have surgery (3 of 75 had P aeruginosa and 7 had GNAB; p < .001). Anaerobes were isolated more often in patients who did not have surgery (69 of 75 patients) than in those who had previous surgery (21 of 33 patients; p < .001). These findings illustrate the unique microbiological features of chronic maxillary sinusitis that persist after sinus surgery.

Adolescent↗
PubMed2005

Microsurgical anatomy of the arterial compartment of the cavernous sinus: analysis of 24 cavernous sinus.

The cavernous sinus is a complex compartment situated in both sides of the sella turcica, being its microsurgical anatomy knowledge of fundamental importance when consider to approach surgically. We studied the arterial microanatomy of 24 cavernous sinus at the microsurgical laboratory, considering that in all the internal carotid artery were filled with colored latex. The meningohypophyseal trunk was present in 18 cases (75%) with its origin in intracavernous portion of the internal carotid artery. In relation to the 18 presented cases with meningohypophyseal trunk, 14 (77.7%) had a trifurcate and 4 (23.3%) had a bifurcate pattern. The tentorial artery was present in all. Its origin was observed, arising from the meningohypophyseal trunk in 17 (70.8%) and as an isolated artery in some extension of the intracavernous portion in 7 (29.1%). An accessory tentorial artery was found in one specimen. The dorsal meningeal artery was present in 22 cases (91.6%). Its origin was in the meningohypophyseal trunk in 17 cases (77.2%), arising from internal carotid artery in 4 cases (18.1%) and from inferior hypophyseal artery in one case (4.1%).The inferior hypophyseal artery was present in all cases, having its origin at the meningohypophyseal trunk in 16 cases (66.6%). In the remaining 8 cases (33.3%) the artery was found arising alone from the intracavernous portion also. The artery of the inferior cavernous sinus or inferolateral trunk was present in all cases and had its origin from internal carotid artery in its intracavernous segment. The McConnell's artery was not found in any cavernous sinus.

Cadaver↗
PubMed2003

Hemangiopericytoma of the confluence of sinuses and the transverse sinuses. Case report.

The authors describe the case of a 38-year-old man with progressive headache and blurred vision related to a hemangiopericytoma located exclusively in the confluence of sinuses (CoS) and in the transverse sinuses bilaterally. They believe this is the first report in which a hemangiopericytoma of the dural sinuses has been described without any intradural component. Although the diagnosis was not suspected preoperatively, a gross-total resection of the tumor with restoration of sinus patency was achieved to relieve the symptoms. This diagnosis should be included in the preoperative differential diagnosis of a tumor of the CoS. Successful resection can be achieved in these cases.

Adult↗
PubMed1999

Endodermal sinus tumor of the maxillary sinus: a case report.

Endodermal sinus tumor is an uncommon malignant germ cell tumor that occurs in both gonadal and extragonadal tissues. Endodermal sinus tumors of the head and neck, exclusive of the central nervous system, are rare. We report a case of endodermal sinus tumor arising from the maxillary sinus in a 4-year-old boy. Combined treatment with radiation therapy and chemotherapy resulted in complete tumor regression.

Child, Preschool↗
PubMed1999

Endoscopic sinus surgery in the isolated paranasal sinus aspergilloma.

Fungal infections of the paranasal sinuses are in four clinical forms. Beside the acute fulminating form, chronic invasive form, allergic fungal sinusitis and fungus ball. Fungus ball is mostly encountered in only one paranasal sinus of an otherwise healthy person. Ten fungus balls of the paranasal sinuses are presented with their management and results.

Adult↗
PubMed2001

[Sinus-nasal polyposis: one-year outcome after endoscopic sinus surgery followed by topical corticosteroid therapy in 72 patients].

Nasal polyposis (NP) is considered as an inflammatory disease for which first line therapy is topical and/or oral corticosteroid. In this paper we attempted to determine the efficacy of endoscopic endonasal surgery followed by topical corticoid in 72 adults suffering from bilateral NP refractory to corticosteroid therapy and to delineate the clinical characteristics of this cohort of patients. NP was confirmed endoscopically and with computed tomography. Visual analog scale for the subjective evaluation and endoscopic examination of the paranasal cavities for the objective evaluation were obtained 3 and 12 months postoperatively. Endoscopic endonasal surgery was based on a radical removal of the NP with wide opening of all the sinuses in the vast majority of the cases. Topical corticoid therapy was started 2 months after surgery. Clinical characteristics of the 72 patients revealed: 29.2% of coexisting allergy; 34.7% of coexisting asthma; 19.4% with food and/or aspirin intolerance. Anterior and posterior ethmoid sinus and maxillary sinus were the most affected sinuses. 53.5% of our patients presented a stage II. One year after surgery we observed that 59.1% of our patients revealed a marked decrease of their symptoms with no polyp on nasal endoscopic evaluation, that 28.8% revealed a marked decrease of their symptoms with recurrence of the NP on nasal endoscopic evaluation and that 12.1% presented moderate to severe symptoms with recurrence of NP on nasal endoscopic evaluation. Based on this experience, we think that endoscopic endonasal surgery will continue to play an important role in the management of NP when the patient becomes refractory to corticoid.

Administration, Topical↗
PubMedDate not supplied

Yamik sinus catheter in the topical treatment of patients with acute rhinosinusitis after previous sinus surgery.

BACKGROUND: The Yamik sinus catheter was designed as a new device for the topical treatment of rhinosinusitis. It creates intermittent positive and negative intranasal pressure after sealing the ipsilateral nostril and choana with two inflatable cuffs. Affecting the nasal cavity and all paranasal sinuses of one side at a time, it is used to evacuate mucous and secretions as well as and to introduce antiseptic, antibacterial, or antifungal solutions. METHODS: This study was designed to evaluate the effectiveness of the Yamik catheter in cases of acute purulent rhinosinusitis in patients who previously underwent endonasal sinus surgery for chronic rhinosinusitis. Twenty patients were treated at repeated visits to the outpatient clinic of our institution. At each visit, their clinical symptoms as well as findings on anterior rhinoscopy, nasal endoscopy, and A-mode ultrasound were evaluated. RESULTS: Acute disease resolved completely within 10 days of treatment in 17 of the 20 patients. Two patients discontinued treatment after repeated visits, showing only mild improvement. One patient felt uncomfortable during the application of the Yamik catheter and did not continue after the initial treatment. CONCLUSION: Our results suggest that the Yamik catheter may be a helpful device in the topical treatment of acute rhinosinusitis and it appears possibly helpful in patients who suffer from episodes of acute purulent infection after previous sinus surgery.

Administration, Intranasal↗
PubMedDate not supplied

Outcome in patients with chronic sinusitis after the minimally invasive sinus technique.

BACKGROUND: Controversy persists regarding the use of minimally invasive sinus techniques (MIST) to treat chronic sinusiris primarily because of an absence of comparative outcome data. METHODS: In this prospective study of 85 patients with chronic sinusitis treated surgically with MIST, the long-term postoperative outcome was assessed using the duration-based Chronic Sinusitis Survey (CSS) quality of life instrument. Patient age ranged from 4 to 81 years old (mean age, 42 +/- 16.7 years). Forty-three subjects were male patients and 42 were female patients. Mean follow-up time was 23.8 +/- 2.2 months. RESULTS: At follow-up, there was a 124.0% improvement in the mean CSS symptom score (p < 0.00001), a 30.1% improvement in the mean CSS medication score (p < 0.00001), and a 62.0% improvement in the mean CSS total score (p < 0.00001). An overall improvement was found in 78.8% of patients; 12.9% of patients were worse and 8.2% of patients were unchanged. Thirty-four patients (40.0%) had postsurgical CSS total scores within the normative interquartile range obtained in healthy controls. Twenty-six of these patients had postsurgical scores that actually surpassed the mean normative CSS total score. Before follow-up evaluation, 5 of the 85 patients (5.9%) had revision surgery after the initial procedure. All had revision MIST procedures and all were found to have an overall improvement at the time of follow-up. CONCLUSION: We conclude that MIST significantly improves the outcome in patients with chronic sinusitis and should strongly be considered as the initial surgical option for such patients.

Adolescent↗
PubMed2002

[A case of cavernous sinus cavernous hemangioma presenting with cavernous sinus syndrome].

The authors report an unusual case of a 50-year-old woman presenting with cavernous sinus syndrome, who had a cavernous sinus cavernous hemangioma (CSCH). The acute onset of her symptoms including pain of the right eye, blephaloptosis of the right eye, diplopia, and sensory disturbance of the right face was similar to those of Tolosa-Hunt syndrome. Magnetic resonance imaging and angiography showed a tumor in the right cavernous sinus. Although she showed improvement of the symptoms after receiving oral corticosteroids, follow-up neuroradiological investigations after a year from the onset revealed the mass in the right cavernous sinus which grew up in size. The histopathological findings obtained from the biopsy of the mass demonstrated a CSCH. Our findings suggest that the growth mechanism of CSCH could be progressive ectasia of vessels or their autonomous development at the edges of the lesions.

Cavernous Sinus↗