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A case of pneumosinus dilatans of the frontal sinus is presented. The findings on serial skull X-rays, performed on three occasions over a 10-year period, seem to support a developmental aetiology for this rare condition.
BACKGROUND: Apoptosis, which is regulated by both cell survival and death signals, is important for the swift clearance of unwanted cells. OBJECTIVE: We sought to elucidate whether eosinophilic apoptosis is associated with tissue eosinophilia and to determine its resolution in allergic sinusitis (AS). METHODS: Numbers of eosinophils, numbers of IL-5(+) cells, and the apoptosis index of eosinophils were calculated in the submucosa (both superficial and deep layers) of patients with AS by using histochemical methods before and after prednisolone treatment. Patients without AS were used for control groups. Anti-EG2 antibody was used to identify eosinophils. IL-5, Fas, or Bax expression of eosinophils was evaluated to elucidate the role of the factors affecting eosinophilic apoptosis. RESULTS: EG2 and IL-5(+) cells were abundant in the submucosa of patients with AS, especially in the superficial layer. About 50% to 60% of the IL-5-producing cells were eosinophils. Apoptotic eosinophils were less numerous in the superficial layer than the deep layer in these diseases. After prednisolone treatment, an induction of eosinophilic apoptosis was accompanied by a significant decrease in the number of EG2(+) and IL-5(+) cells. No remarkable difference was observed in the Fas or Bax expression of eosinophils after prednisolone treatment. CONCLUSION: Autocrine secretion of IL-5 from eosinophils may be one reason why eosinophilic disease is difficult to manage. Induction of eosinophilic apoptosis is critical for reversing tissue eosinophilia in patients with AS.
A new pressure flow method for function tests and calculation of the airway resistance in the naso-frontal duct is presented. With this pressure flow technique the function and airway resistance of the naso-frontal duct was tested in 49 patients who were trephined for acute frontal sinusitis. The tests were performed during the primary healing period (0-16 days) and in a long term study 2, 6 and 12 months after operation. The patients were also checked radiologically and clinically. A prolonged healing period (more than 6 days) corresponded significantly to a high incidence of recurrent disease. With this method it is possible to define groups where recurrences might be expected because of impaired function of the naso-frontal duct.
Fifty-five consecutive patients had ultrasonic examination and routine radiology of the maxillary sinus prior to proof puncture. One hundred and eight antra were washed out and a positive aspiration was obtained in 20% (22). A clear return correlated with a normal radiograph and ultrasound in 91% and 85% of sides respectively. Radiographic results gave a 9% false negative result whereas 15% of normal ultrasounds had a return on proof puncture. Abnormal radiographic appearances and ultrasound traces were correlated with a positive return in 28% and 27% of punctures, respectively. It is concluded that ultrasound adds little further information and does not improve upon radiology in predicting the presence of fluid within the maxillary antrum.
The close relationship of the teeth and the maxillary sinus requires both communication and cooperation between the dentist and the ENT specialist to ensure the best outcome for the patient.
ABT-492 exhibited excellent in vitro activities against all 326 aerobic and anaerobic antral puncture sinus isolates tested with MICs (in micrograms per milliliter) at which 90% of the isolates tested were inhibited as follows: Haemophilus influenzae, 0.001; Moraxella catarrhalis, 0.008; and Streptococcus pneumoniae, 0.015. It was four- to sixfold more active than other fluoroquinolones, including against levofloxacin-resistant strains of S. pneumoniae, methicillin-resistant Staphylococcus aureus, and Prevotella species.
Actinomycosis of the paranasal sinuses is a rare occurrence and its clinical presentation does not suggest a specific diagnosis. Therefore, actinomycosis should be included in the differential diagnosis of neoplasms and granulomatous lesions of the head and neck region. However, the differentiation from a malignant neoplasm is not easy because the radiological findings are frequently similar and positive cultures are difficult to obtain. This report highlights the clinical progress of paranasal actinomycosis associated with some computed tomography findings that can be extremely helpful in the correct diagnosis. The characteristics of the disease are described and the relevant literature is discussed.
Posttransplantation lymphoproliferative disorder (PTLD) is a challenging complication associated with organ transplantation and is usually fatal if untreated. We describe the case of a transplant recipient who presented with rapidly progressive cranial nerve palsies due to PTLD that originated in the sphenoid sinus. In this case, the clinical and radiologic presentation of PTLD mimicked invasive fungal disease. Because the management of PTLD and the management of invasive fungal infection are vastly different, prompt pathologic diagnosis is required.
The authors report the MRI findings in a patient with cavernous sinus metastasis with inferior extension to the nasopharynx, mimicking imaging findings of the advanced nasopharyngeal cancer with the skull base, and intracranial extension. Findings of denervative atrophy of the masticator muscles and obstruction of the Eustachian tube resulting in fluid retention of mastoid air cells are seen in both processes.
A review of the literature shows that intraoral lipomas are more common than they are generally believed to be. The clinical course of a case with unusual localization, size and clinical manifestation of an angiolipoma of the maxillary sinus is described. Differential diagnosis with other types of intraoral lipomas is made.
The authors examine the correlations among standard X-ray, sinuscopy and sinusomanometry for 465 maxillary sinuses in the adult. Good overall correspondence does exist between radiography and sinuscopy (51.59 to 90.91%) but there is no real correlation between sinusomanometry and a sinuscopy that fails to visualize the ostium. Correlation is excellent when the morphologic appearance of the ostium is studied in conjunction with the sinusomanometric findings (82.09%). This study demonstrates the morphologic and the functional examinations to be rigorously complementary and indissociable.
One hundred and twenty adults have benefitted from a full staging of their chronic maxillary sinusitis. The authors detail the place of endoscopy in the assessment and management of the different clinical presentations. The endoscopy will be useful only if a systematic examination is performed, of nose and paranasal cavities, both optically and manometrically. Nature and severity of the disease can be evaluated by summarizing of the patient findings of story, clinical, radiological examinations and biological data. Endoscopy constitutes nor a valuable diagnostic tool, nor a therapeutic approach, conducting conservative treatment and avoiding some radical surgery.
After a brief historical review, the authors describe, the material and methods of sinuscopy. The advantages and inconveniences of sinuscopy are then discussed. In conclusion the indications for endoscopy in sinusitis are given and it appears that sinuscopy is a very good way to show the reliability of the standard radiographs as well as the CT scan.
We report our experience with 10 cases of sphenoidal aspergillomas treated by endoscopic sinus surgery (ESS). Chronic symptoms such as cough, post-nasal discharge, dysphonia and even facial pain can be encountered in the history. Computerised tomography and, occasionally, magnetic resonance imaging are of great help in the assessment of this disease, especially when extensive skull base involvement is present. The radiological presentation can vary from an heterogeneous to homogeneous opacity with or without bone lysis to a frank pseudotumoural appearance. Four diagnostic tools have been evaluated to confirm the diagnosis: histology, direct smear, fungal cultures, and serology for Aspergillus. ESS has been successfully carried out without morbidity in all cases. No recurrence of the disease is seen after a mean follow-up of 27 months.
An intra-atrial recording technique previously employed in animal experiments was successfully used to record SNP from the anatomic sinus nodal region of the high right atrium in 29 out of 41 patients (71%) thus examined. Due to the low amplitudes (microvolt range, 40 to 120 microV, mean 79 +/- 20 microV), these potentials were discernible only on high amplification (A = 10(4) to 10(6)), but with a conventional electrode catheter. Against the background of a gradual diastolic depolarization (0.6 to 3.5 microV/msec, mean 1.9 +/- 0.71 msec), SNP stood out distinctly from the subsequent abrupt atrial depolarization. In four patients with SSS, first- and second-degree sinoatrial blocks, respectively, were recorded. SACT were measured both directly and indirectly, and the results were compared in all 18 patients without SSS and in 11 patients with SSS. Although the recordings were not made simultaneously, the paired values for the patients without SSS correlated well (r = 0.890, p less than 0.001), whereas no correlation was found in the patients with SSS (r = 0.163, p = 0.316). In spite of unresolved questions, direct recording of SNP appears to be of potential value in evaluating patients with SSS.
The author examined whether respiratory sinus arrhythmia (RSA) responses to stress predicted resting RSA approximately 3 years later in children and adolescents. A total of 149 children and adolescents (49% girls and women, 44% African Americans) participated in 2 laboratory protocols approximately 3 years apart. RSA reactivity during tasks was consistent within participants across tasks during each session. Resting RSA at Visit 1 explained 17% of the variance in resting RSA at Visit 2 when body mass index, duration between visits, race, gender, and age were controlled for. Visit 1 RSA reactivity explained an additional 5% of the variance in resting RSA at Visit 2. The positive relationship between Visit 1 reactivity and Visit 2 resting levels suggests that larger decreases in RSA during stress predicted lower resting RSA. Conversely, increases in RSA during stress were associated with higher resting RSA an average of 3 years later.
Mucocoeles of the paranasal sinuses often enlarge slowly resulting in local bone erosion with subsequent extension into the adjacent orbit or intracranial space. We have reviewed the management of 59 patients with 68 mucocoeles. The variety of presentations is examined and discussed. Although diplopia has previously been stated as a very common finding we have found this not to be the case and believe that it may be that previous reports originate from ophthalmology centres. Forty-four patients underwent endoscopic surgical management of their mucocoeles, nine had a combined external and endoscopic procedure and 14 patients had an external approach. One patient needed no surgery. The mean follow-up period was 6 years 3 months. There was the lowest number of recurrences in the endoscopic surgical group. We emphasize the importance of long-term follow-up.
Lectin expression in both normal and inflamed sinus mucosa in rabbit was investigated histochemically. A different staining pattern was observed in the inflamed mucosa, i.e. the degree of staining reactivity with Canavalia ensiformis (ConA) decreased, whereas staining with Ulex europaeus agglutinin-I (UEA-I), Arachis hypoga (PNA) with neuraminidase pretreatment and Triticum vulgaris (WGA) intensified, indicating an enhanced fucosylation as well as sialylation. Goblet cells were stained with UEA-I, WGA, PNA and PNA with neuraminidase pretreatment, but scarcely with ConA. Positive PNA staining of basal cells and epithelial secretory granules was observed in the inflamed mucosa, especially close to areas where goblet cell development was prolific. It was therefore assumed that basal cells can differentiate into goblet cells-through epithelial secretory cells accompanied by sialylation and/or sulphonation of their mucins. It is concluded that the changes in glycoconjugate expression as well as goblet cell development in the inflamed mucosa are of importance for both local host resistance and defence mechanisms against microorganisms during the early stages of the inflammatory process.