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PubMed1997

Detection of rhinovirus in sinus brushings of patients with acute community-acquired sinusitis by reverse transcription-PCR.

Of 20 adults with acute community-acquired sinusitis (ACAS), rhinovirus was detected in specimens from 10 (50%) patients, including maxillary aspirates from 8 (40%) patients and nasal swabs from 9 (45%) patients, by reverse transcription-PCR (RT-PCR). Human coronavirus was detected by RT-PCR in nasal swabs from 3 of 20 patients but in no sinus secretions. These findings suggest that rhinovirus is an important cause of ACAS and that viral invasion of the sinus cavity itself may be a common event during the disease.

Adult↗
PubMed2001

Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. For The Cerebral Venous Sinus Thrombosis Study Group.

The prognosis of cerebral venous sinus thrombosis (CVST) is variable, and outcome may range from complete recovery to death. Prognostic factors to predict outcome in the acute phase of CVST have not been analysed in a prospective study. Prognostic factors in patients enrolled in a clinical treatment trial were prospectively investigated. Poor outcome after 12 weeks, defined as death or dependency (Oxford handicap score > or =3), was used as the principle outcome measure. Univariate relations between possible prognostic factors and outcome at 12 weeks were analyzed with chi(2) tests. Treatment and all factors associated with prognosis (p< or = 0.25) were forced into a logistic regression model with a forward selection procedure. Fifty nine patients (50 women, nine men) were studied, with a mean age of 37 years (range 18 to 80 years). After 12 weeks 10 patients (17%) had a poor outcome. The univariate identified factors related to poor outcome were papilloedema, altered consciousness, coma, age older than 33 years, diagnostic delay < or =10 days, intracerebral haemorrhage, and involvement of the straight sinus. Isolated intracranial hypertension and a delta sign on CT were associated with good outcome. In the multivariate analysis coma and cerebral haemorrhage were significantly associated with a poor outcome, with odds ratios of 8.2 (95% confidence interval (95% CI) 1. 3-50.1) and 20.7 (95% CI 1.6-264.3) respectively. Involvement of the straight sinus was also weakly, but not significantly, associated with poor outcome. In conclusion, coma and intracerebral haemorrhage are independent predictors for poor outcome of CVST.

Adolescent↗
PubMed1980

Carotid sinus reflex in patients undergoing coronary angiography: relationship of degree and location of coronary artery disease to response to carotid sinus massage.

Heart rate and blood pressure responses during and after carotid sinus massage were examined in 66 patients just before coronary angiography. A significant relationship was found between heart rate and blood pressure responses and (1) angina pectoris class, (2) total coronary artery disease score and (3) presence of high-grade (> 90%) stenosis of any of the three major coronary arteries. Only patients with contraction abnormalities of the anterolateral left ventricular region had greater cardionhibitory responses than patients with normal left ventricular angiograms. Among patients with normal left ventricular angiograms, those with more than 50% stenosis of one or more vessels had significantly (p < 0.01) greater responses than those with no or minimal coronary artery disease. All 21 hypersensitive (asystole longer than 3 seconds) patients had significant multivessel coronary artery stenoses or single-vessel high-grade stenosis (greater than or equal to 90%) proximal to the atrioventricular nodal artery. None of the 11 patients with normal coronary arteries had an exaggerated response to carotid sinus massage. These data support the association of an exaggerated response to carotid sinus massage in the presence of symptomatic coronary artery disease and suggest that the magnitude of response is influenced by the severity of the disease.

Adolescent↗
PubMed1999

Documentation of the prevalence of penicillin-resistant Streptococcus pneumoniae isolated from the middle ear and sinus fluid of children undergoing tympanocentesis or sinus lavage.

With increasing pneumococcal resistance to penicillin and other antibiotics, use of antibiotic therapy for children with upper respiratory tract infections such as otitis media and sinusitis has become difficult. Selecting an appropriate treatment regimen has become more challenging due to frequent concomitant microbial resistance to multiple antibiotics. In a prospective, nonrandomized study, we obtained middle ear and sinus aspirate specimens from all children undergoing outpatient tympanocentesis or sinus lavage for any indication at our institution over two 4-week periods. One hundred fifty-four specimens were obtained. Of these, 12 grew Streptococcus pneumoniae, 7 of which were resistant to penicillin. A 6-month retrospective review of these patients' medical histories evaluated their antibiotic use prior to surgical intervention. An association between penicillin resistance and recent use of 2 or more antibiotics in children with positive S pneumoniae cultures was confirmed, as has been documented in prior reports. Those with penicillin-resistant S pneumoniae also demonstrated a higher incidence of multidrug-resistant organisms.

Body Fluids↗
PubMedDate not supplied

Moxifloxacin in the treatment of acute maxillary sinusitis after first-line treatment failure and acute sinusitis with high risk of complications.

This multicentre, prospective study evaluated the efficacy and safety of 7-day oral moxifloxacin (400 mg/day) for treatment of acute maxillary sinusitis after first-line treatment failure (group 1), and acute sinusitis with high risk of complications (group 2). Two hundred and fifty-eight patients with radiologically confirmed acute sinusitis were enrolled by 52 investigators; 216 patients (83.7%) qualified for per protocol efficacy analysis (group 1, n = 175; group 2, n = 41), and 92 for bacteriological analysis. Samples were collected from the middle meatus. The clinical success rate 7-10 days post-treatment was 92.6%. Bacteriological success rates were 95.7% after 3-4 days of treatment, and 97.2% and 95.2%, in group 1 and group 2, respectively, at 7-10 days post-treatment. Drug-related adverse events, including abdominal pain (2.4%), nausea (2.4%) and diarrhoea (1.2%), were reported in 12.2% of patients. Overall, moxifloxacin therapy resulted in rapid bacteriological eradication, with a high rate of clinical success.

Acute Disease↗
PubMed2002

Comparative evaluation of functional endoscopic sinus surgery and conventional surgery in the management of chronic sinusitis.

Fifty patients with signs and symptoms of chronic sinusitis and refractory to medical treatment constituted this study. They were divided at random into two groups of 25 patients each. Group A (study group) patients were subjected to functional endoscopic sinus surgery (FESS) and group B (control group) patients were treated by conventional surgery. The age of the patients varied from 16-55 years (mean 29.1). Out of 25 patients in the study group, 19(76%) had complete relief of symptoms, 4(16%) had partial relief of symptoms and 2(8%) had no relief of symptoms in the follow-up period of 15-33 months (mean 19.2 months). Out of 25 patients in the control group, 15(60%) had complete relief of symptoms, 4(16%) had partial relief of symptoms and 6(24%) had no relief of symptoms in the follow-up period of 15-33 months (mean 19.2 months). The results of this series revealed that FESS had the combined advantages of precise, atraumatic removal of the disease with minimal morbidity and at the same time retaining the physiological function of the nose and paranasal sinuses.

Adult↗
PubMed1975

[Three cases of spontaneous bilateral external carotid-cavernous sinus fistula (dural arteriovenous shunts in the region of the cavernous sinus) (author's transl)].

Since Fincher reported a case with arteriovenous fistula between the external carotid artery and dural sinus, many type of cases have been reported. On the other hand, so called the external carotid avernous fistula has been recognized less 20 cases in literature. We have observed three additional cases of dural arteriovenous shunts in the region of the cavernous sinus. Case 1. A 52 year old woman had suffered from left side sever headache. There was weakness of the left extraocular muscles and left ptosis. A bruit was heard over the left orbit. She was treated for hypertension since 38 year old. And she has no history of recent trauma. Selective internal and external carotid angiographies showed the bilateral external carotid cavernous sinus fistula. No operative treatment was performed in this case and the symptomes disappeared with decrease of blood pressure. Case 2. A 50 year old man came to this clinic with chief complaints of right ptosis, diplopia and headache. He was treated for diabetes mellitus and hypertension for six month...

Arteriovenous Fistula↗
PubMed2002

Healing results of prolonged acute frontal sinusitis treated with endoscopic sinus surgery.

In a marked part of patients suffering from acute frontal sinusitis, the symptoms do not resolve after initial therapy (antibiotics and/or trephination). The prolongation of the healing or recurrences may be caused by persistent inflammation or by structural abnormalities at the nasofrontal connection. During the last decade endoscopic surgery (FES) has become a very useful method to restore the frontonasal drainage although long term results of this kind of population are rare. We evaluated the results of endoscopic surgery in two patient groups (total number of 50) both operated after prolongation (persistent symptoms after 4 weeks) of the initial acute phase of the frontal sinusitis. The first group (A, 15 patients, first trephined) was followed-up 4 years, the number of recurrences after the first FES was 60% and in the other group (B, no initial trephination) with over 6 months follow-up, 91% of patients had recurrences. In group A pre- and postoperative CT-scanning was used to determine the possible anatomical variations that could be causing the failures. All but 3 patients showed some kind of abnormal anatomical variation. In group B only preoperative CT was done. In most cases the reasons for recurrences of frontal sinusitis were polyps and/or chronic inflammation at the ethmoidal region.

Acute Disease↗
PubMed2002

[Endoscopic sinus surgery for recurrent sinusitis and nasal polyps].

OBJECTIVE: To study the treatment methods of improving the operative effect and reducing the complications of chronic sinusitis and nasal polyps. METHOD: Two hundred and eighty cases with chronic sinusitis and nasal polyps were performed with endoscopic sinus surgery. RESULT: The long-term follow-up was performed at 6 and 12 months after operation, the results showed that the total effective rate were 85.75% (the cure rate was 58.2%; the improvement rate was 27.5%) and 81.4% (the cure rate was 54.6%; the improvement rate was 26.8%) respectively, the complication rate was 9.3%. CONCLUSION: Correct operation choices, preoperative and postoperative combing treatment and excellent surgical skills are keys of improving the operative effect and reducing the complications.

Adolescent↗
PubMedDate not supplied

Effect of asthma on sinus computed tomography grade and symptom scores in patients undergoing revision functional endoscopic sinus surgery.

BACKGROUND: The aim of this study was to determine the influence of asthma on sinus computed tomography (CT) grade, endoscopic appearance, and symptom scores in patients undergoing revision functional endoscopic sinus surgery (FESS). METHODS: Prospective data was collected of patients undergoing revision FESS at a tertiary medical center over a 2-year period. CT scans were graded as per the Lund and Mackay system. Patient symptom scores were recorded from the Sino-Nasal Outcome Test (SNOT 20) inventory and individual symptoms from the Rhinosinusitis Task Force major and minor symptom list were graded on a visual analog scale. RESULTS: Eighty patients underwent revision FESS and 20 of those patients had asthma. The average CT grade in asthmatic patients was 18.6 compared with 11.7 in patients who were nonasthmatic (p = 0.000006). The average SNOT 20 symptom score in patients with asthma was 49.6 and in nonasthmatic patients it was 44.9 (p = 0.238). Both asthmatic and nonasthmatic patients experienced a reduction in SNOT 20 symptom scores at 1 year with reductions of 70% (p = 0.0000) versus 72.6% (p = 0.0000), respectively. CONCLUSION: Patients with asthma undergoing revision FESS had higher sinus CT grades compared with patients without asthma. Asthmatic and nonasthmatic patients had statistically significant reductions in symptoms scores after revision FESS. Asthmatic patients had similar symptomatic relief scores after revision FESS as compared with nonasthmatic patients.

Adolescent↗
PubMed2004

[Non invasive fungal sinusitis: mycetoma and alergical fungal sinusitis].

We have made a study about different cases of non-invasive fungal sinusitis (FS) treated at our hospital with surgery (endoscopic sinus approach) and medical treatment. We review two cases: Mycetoma and allergic fungal sinusitis, following the recent classification based on physiopathology, treatment and prognosis. We review the clinical presentation of the different types.

Adult↗
PubMedDate not supplied

Th2 immunological inflammation in allergic fungal sinusitis, nonallergic eosinophilic fungal sinusitis, and chronic rhinosinusitis.

BACKGROUND: Noninvasive fungal sinusitis is a heterogenous group of conditions including allergic fungal sinusitis (AFS) and nonallergic eosinophilic fungal sinusitis (NEFS). Th2-mediated cascades have been postulated to be the major inflammatory response in patients with AFS although other mechanisms also may be involved. The detailed mucosal Th2 cytological status of NEFS still has not been studied in great depth. METHODS: Using a meticulous patient selection algorithm over a 2-year period, infundibular mucosal tissue from patients with AFS, NEFS, chronic rhinosinusitis (CRS), and normal controls was studied (n = 59). Immunohistochemistry for mast cells, eosinophils, and immunoglobulin E (IgE) cells was performed and cell counts per unit area were measured. RESULTS: Mast cell, eosinophil, and IgE+ cell numbers were significantly raised in patients with AFS, NEFS, and CRS when compared with controls. There was no significant difference between cell numbers in patients with AFS and NEFS. CONCLUSION: Patients with AFS exhibit a classic Th2 inflammatory response in nasal mucosal tissue with NEFS and CRS patients showing evidence of a similar Th2 cascade, including the presence of IgE+ cells.

Adolescent↗
PubMed1978

[Diagnosis of sick sinus syndrome: sinus node recovery time as a bedside-investigation (author's transl)].

Prolonged sinus node recovery time is the most important diagnostic parameter of the sick sinus syndrome. In consideration of the therapeutic proceeding (antiarrhythmic drugs, pacemaker implantation or combination of these two therapeutic measures) an exact diagnostic proceeding is desirable. In 103 atrial stimulations we found in 42 cases a prolonged sinus node recovery time. There are shown details, which make the atrial stimulation practicable as a bedside-investigation.

Aged↗
PubMed1978

[The effect of diphenylhydantoin on the automatism of the sinus node and on the sino-atrial conduction time in patients with and without sick sinus syndrome].

In 30 test persons (15 patients with disturbed function of the sino-auricular node, 9 of them with classical sick-sinus-syndrome as well as 15 test persons without disturbance of the sino-auricular node, of them 7 healthy ones) the influence of diphenylhydantoin on the function of the sino-auricular node was tested. By means of atrial stimulation the so-called sino-atrial conduction time, the recreation time of the sino-auricular node as well as the duration of the sinus period before and after intravenous application of 250 mg of diphenylhydantoin was estimated. The auricular stimulation was carried out either through an oesophageal electrode probe or usually through an electrode catheter directly placed in the right atrium. In the entire collective the sino-atrial conduction time did prolong itself statistically not significantly by 2 +/- 5ms (x +/- 2 s), in which cases there was not to be observed a different behaviour between test persons with a healthy rhythm and patients with disturbed function of the sino-auricular node. In 2 patients with sick-sinus-syndrome, however, after diphenylhydantoin and individual atrial stimulation in each case sino-atrial blockings of higher degree developed. The maximum absolute and corrected recovery time of the sino-auricular node prolonged itself in patients with syndrome of the sino-auricular node by on an average 1406 +/- 2120 ms or 1378 +/- 2338 ms, in which cases in 1 test person a threatening prolongation of the poststimulation pause to 10 s developed. In another patient after application of diphenylhydantoin an atrial arrest was observed. The automatism of the sino-auricular node of test persons with healthy rhythm was not influenced.

Arrhythmia, Sinus↗
PubMed1982

[Clinical significance of corrected sinus node recovery time and natural and unnatural history of sinus node dysfunctions. A four-year prospective follow-up of 101 cases].

The clinical significance of corrected sinus node recovery time (CSNRT) and the natural and unnatural history of sinus node dysfunctions are not completely known. To gain some insight into this problem, 101 patients (pts) (54M, 47F, mean age +/- SD = 62.02 yrs +/- 14.42) with clinical and ECG signs of definite or suspected sick sinus syndrome (SSS) underwent an electrophysiologic study and then were prospectively followed for a mean period of 44.36 months +/- 18.96 (range: 2-78 months). The pts were divided into two groups: 1) Group A: 68 pts with prolonged CSNRT (greater than 500 msec); 2) Group B: 33 pts with normal CSNRT. Thirty-three pts of Group A (48.5%) and 2 pts of Group B (6.1%) received VVI pacemaker implantation (PM) immediately after the electrophysiologic study. The following results were obtained: 1) Pts of Group A showed a higher prevalence of organic heart disease and of ECG signs of definite SSS than pts of Group B. (p less than 0.05). Moreover, the higher the CSNRT in Group A pts, the more severe the ECG abnormalities of SSS. 2) Pts without PM, both of Group A and Group B, noted during the follow-up period a disappearance of neurological symptoms (syncopes and/or dizziness) and of ECG abnormalities of SSS in more than 50% of the cases. However, this was less evident in Group A pts compared with Group B pts (53.8% vs 78.6% regarding neurological symptoms and 54.3% vs 74.1% regarding ECG abnormalities of SSS) as well as in pts with organic heart disease in comparison with those with primitive SSS. Moreover, the number of pts who needed PM implantation during the follow-up period due to the worsening of clinical and ECG signs of SSS were higher in Group A than in Group B (20% vs 6.5%). The occurrence of cardiac death among the pts without PM was similar in pts of Group A (8.5%) and in those of Group B (9.7%). One pt of Group A without PM died suddenly (less than 1 hour). 3) Pts who required PM implantation were older (p less than 0.01) and showed a prevalence of organic heart disease higher (p less than 0.05) than those who did not require PM implantation. Pts with PM, both of Group A and Group B, showed a complete disappearance of syncopes and a clear-cut reduction of dizziness after implantation of it. On the contrary, dyspnea nearly always persisted and sometimes appeared when initially absent. Sudden and non-sudden cardiac death in PM pts (13.6%) was somewhat more frequent than in those without PM. 4) The incidence of stable atrial fibrillation was 12.1% in pts without PM and 27.2% in pts with PM. The occurrence of stable atrial fibrillation in pts without PM was generally not followed by clinical improvement. 5) The incidence of cerebrovascular accidents was approximately 8%. The accidents always occurred in pts with organic heart disease and often in the older pts (mean age: 75.1 yrs +/- 5.7) particularly in those with PM. A bradycardia-tachycardia syndrome was observed only in 3 pts who had a stroke...

Cardiac Pacing, Artificial↗
PubMed1995

Nasal specific technique as part of a chiropractic approach to chronic sinusitis and sinus headaches.

OBJECTIVE: To demonstrate the use of nasal specific technique in conjunction with other chiropractic interventions in managing chronic head pain. CLINIC FEATURES: A 41-yr-old woman was treated for chronic sinusitis and sinus headaches. She had suffered weight loss and pain over a 2-month period. INTERVENTION AND OUTCOME: Chiropractic manipulation and soft tissue manipulation administered 2-6 times per month for approximately 1 yr had minimal long-term effect on the patient's head pain. When additional interventions (nasal specific technique and light force cranial adjusting) were added to the treatment regimen, significant relief of symptoms was achieved after the nasal specific technique was performed. The duration of the relief increased with successive therapeutic sessions, with minimally persistent symptoms after 2 months of therapy. CONCLUSION: The nasal specific technique, when used in conjunction with other therapies, may be useful in treating chronic sinus inflammation and pain. Further investigation is needed to identify the usefulness of the nasal specific technique as an independent intervention, the use of the technique in other types of patients and presentations, and the mechanism of therapeutic benefit.

Adult↗
PubMed1993

Sinus CT scan: an essential in sinus disorders and surgery.

This paper stresses the importance of CT scans in the evaluation of sinus disorders and in providing valuable anatomic information to the sinus surgeon to reduce the risks of surgical complications. The scans may also detect discreet pathology, otherwise missed, that may be responsible for unexplained symptoms like headache, facial pains, cough, midfacial congestion and postnatal drip. The CT technique and limitations are briefly discussed. The MRI is not recommended as a routine study in sinus disorders.

Chronic Disease↗