Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “sinusitis”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,495 records · Page 83Linked to original sources
PubMed1992

Investigation into allergic response in patients with chronic sinusitis.

We attempted to investigate the role of nasal allergy in sinusitis to elucidate whether it results from an immediate-type allergic reaction of the sinus mucosa or from allergic edema-induced sinus ostial obstruction. Forty-two patients with chronic sinusitis were selected for allergen skin tests, measurements of serum total and specific IgE, and sinus tissue-specific IgE. The data were then correlated to examinations of nasal mucosal scrapings and histopathology of the sinus mucosa. We found that serum levels of total IgE and house dust mite-specific IgE antibodies were significantly higher in patients (n = 12) allergic to house dust than in the nonatopics (n = 30; p less than 0.0001). There was no difference in the sinus tissue-specific IgE antibody. Eosinophils and basophilic cells in epithelial scrapings from the inferior turbinates, assessed by Hansel staining, were high in 66.7% and 50% of the atopic patients, respectively, and 36.7% and 26.7% of the nonatopics, respectively. The rates were influenced by the existence of infection and nasal polyps. The increase in eosinophils, mast cells and plasma cells, assessed by histopathologic examination, were not prevalent in the sinus mucosa of atopic patients. It is concluded that nasal allergy may be a predisposing factor to sinusitis and that the pathologic change of the sinus mucosa is mainly secondary, due to sinus ostial obstruction.

Adult↗
PubMed2005

Prevalence of etiologic bacteria and beta-lactamase-producing bacteria in acute and chronic maxillary sinusitis at Phramongkutklao Hospital.

BACKGROUND: To date, there is an increasing trend of prescribing antibiotics that cover beta-lactamase-producing bacteria as the first line drug for sinusitis patients in Thailand This practice dose not only increases the treatment cost but might also induce resistance to antimicrobial agents. OBJECTIVE: To determine the prevalence of the pathogenic bacteria in acute and chronic maxillary sinusitis as well as the prevalence of beta-lactamase-producing bacteria. MATERIAL AND METHOD: The maxillary aspiration fluid specimens of 52 acute and chronic sinusitis patients at Phramongkutklao Hospital, Bangkok, Thailand during May 2002-May 2003, were collected. Aerobic and anaerobic cultures were performed and the beta-lactamase activities of isolated bacteria were determined. RESULTS: Of 58 specimens, 44 (75.9%) and 14 (24.1%) specimens were collected from acute and chronic maxillary sinusitis patients, respectively. Of 44 specimens of acute maxillary sinusitis, the predominant isolates were Haemophilus influenzae (13, 29.5%), Streptococcus pneumoniae (4, 9%), Streptococcus viridan (4, 9%), and Klebsiella pneumoniae (4, 9%). 6 (13.6%) of them were beta-lactamase-producing bacteria. Of 14 specimens of chronic maxillary sinusitis, the predominant isolates were Pseudomonas aeruginosa (3, 16.6%), Staphylococcus spp (3, 17.5%) and Streptococcus spp. (2, 11.6%). 1 (7.1%) Haemophilus influenza isolate from this group was beta-lactamase-producing bacteria. The percentage of anaerobe was 8.9%, 23.3% for acute and chronic maxillary sinusitis, respectively. CONCLUSION: The present study was indicated that the common organisms in acute maxillary sinusitis were Haemophilus influenzae and Streptococcus pneumoniae, Streptococcus viridians which were similar to a previous study. But the authors found an increased prevalence of anaerobe bacteria in acute maxillary sinusitis and also found beta-lactamase-producing bacteria, 21.4% Hemophilus influenzae less than the previous studies (which found beta-lactamase-producing bacteria around 50% to 70%). The authors found 23.3% anaerobe bacteria in the chronic maxillary sinusitis, less than the previous studies, and the authors also found 8.9% anaerobe in acute maxillary sinusitis.

Acute Disease↗
PubMed2006

[Histopathological study on the regularity of pyriform sinus carcinoma invading adjacent tissue and structure].

OBJECTIVE: To explore the regularity invading adjacent tissue of pyriform sinus carcinoma. METHODS: The whole organ serial section of 68 total or partial laryngectomy and hypopharyngectomy specimen of pyriform sinus carcinoma were histopathologically studied. RESULTS: In 68 pyriform sinus carcinoma, invaded ventricular and paraglottic spaces was 63 and 38 cases respectively, the difference of invasive frequency of both spaces was significantly marked (chi2 = 21.37, P < 0.01). Thyroid cartilage had the most invaded frequency of 92.6% (63/68). The all touching and pressing invasion of laryngeal cartilage was 89 times, and infiltrating invasion was 51 times. The invasive frequency of lateral cricoarytenoid muscle, posterior cricoarytenoid one, thyroarytenoid and interarytenoid ones were 63.2% (43/68), 57.4% (39/68), 55.9% (38/68), 51.5% (35/68) respectively. The invasive frequency of cricoarytenoid and cricothyroid joints were 30.9% (21/68), 17.6% (12/68) respectively. The invasive frequency of superior laryngeal nerve was 67.7% (44/65) , and more than that of recurrent laryngeal nerve (18/65, 27.7%). The pyriform sinus medial wall carcinoma was 14 cases, lateral wall carcinoma 18 cases, medial and lateral wall carcinoma 36 cases. The invaded pyriform sinus apex was 34 cases, normal its apex was 26 ones, submucous invasion of its apex was 8 ones. Light lymphocytic invasion was 66.2% (45/68) and seen most in pyriform sinus carcinoma. Submucous and leaping invasion of pyriform sinus carcinoma were 24 and 8 cases. CONCLUSIONS: Intralaryngeal invasion of pyriform sinus carcinoma arose through paraglottic space first. Laryngeal cartilage membrane and their cartilage were anatomical obstacle against cancerous invasion. Lateral cricoarytenoid muscle, posterior cricoarytenoid one, thyroarytenoid and interarytenoid ones were often invaded. Pyriform sinus medial wall carcinoma invaded intralaryngeal structure easily, its lateral wall carcinoma may invade upward, downward and outward along thyroid cartilage interior wall, medial and lateral wall carcinoma may invade intralaryngeal and extralaryngeal structure, and was the most serious lesion. The invasion of pyriform sinus apex is an important sign of pyriform sinus carcinoma spreading downward to inferior and peripheral tissues of hypopharynx.

Adult↗
PubMed1991

[Carotid sinus syndrome diagnosed by transcutaneous cardiac pacing].

The diagnostic usefulness and safety of non-invasive heart stimulation has been tested on 20 persons with full symptomatic cardiodepressive type of carotid sinus syndrome. The estimation of the cardiodepressive syndrome has been conducted on the grounds of electrophysiological tests of the heart with the method of endocavitary stimulation introduced by Stryjer and adopted by us for non-invasive heart stimulation. Massage of the carotid sinus was performed during sinus rhythm, during transesophageal atrial stimulation and during transcutaneous ventricle stimulation. In 17 persons massage of the carotid sinus caused sinus node inhibition. In this group carotid sinus massage during atrial stimulation revealed a group of 10 persons with only sinus node inhibition (type A) and a group of 7 persons with the coexistence of sinus node inhibition and an AV III block (type C). Only in 3 persons massage of the carotid sinus merely caused an AV III block (type B). Massage of the carotid sinus during transcutaneous ventricle stimulation showed retrograde AV conduction suppression in type B and C of the carotid cardiodepressive syndrome. To recapitulate the obtained results, it can be assumed that electrophysiological estimation of the carotid sinus syndrome is also possible and safe with the non-invasive method. Such procedure can also facilitate the selection of patients for permanent stimulation of AAI type for the type A syndrome or DVV for types B and C.

Atrioventricular Node↗
PubMed1991

[Investigation of fat in the dural sinus].

Detection of fat in the cranium usually indicates the presence of a fat-containing tumor such as lipoma, dermoid cyst or teratoma. However, since 1982, Hasso et al demonstrated with CT the presence of normal adipose tissue in the cavernous sinus, the mere existence of fat in the cranium does not necessarily mean the presence of a fatty tumor. The author first described fat deposition in the superior sagittal sinus and torcular Herophili following a CT study performed in 1986. The purpose of this study was to investigate the distribution, frequency, and anatomical correlations of fat in the dural sinus as demonstrated on CT. Fat was detected in the cavernous sinus in 20% of all cases (492/2408), and occurred more frequently (25%) in those older than 50 years. Fat was less frequent in the other dural sinuses (3%; 75/2296). The most common location was the torcular Herophili, followed in decreasing order of frequency by the straight sinus, inferior sagittal sinus, superior sagittal sinus and transverse sinus. Pathological examination was performed in three cases. Fat deposition was composed of normal adipose tissue and was devoid of fibrous encapsulation or infiltration. In one case, the fat seemed to be partly exposed to the subarachnoid space on CT, whereas on autopsy, thin dura mater covering the fat nodule was confirmed. Fat in the dural sinus must be differentiated from cavernous nodule or sinus thrombosis. The Hounsfield unit may be helpful in making a definitive diagnosis.

Adipose Tissue↗
PubMed1983

[Sick sinus syndrome: comparative study of atrial and ventricular stimulation tests].

Subjects with a ventriculo-atrial block and normal sinus function exhibit acceleration of the sinus rhythm during incremental right ventricular pacing; this acceleration is nor observed or is hardly visible in patients with sinus node dysfunction. Incremental right ventricular pacing up to 150/min was performed in 16 patients with ventriculo-atrial block (Group A) referred for investigation of sinus node dysfunction and the results compared with the classical tests of atrial pacing (Strauss'graph, atrio-sino-atrial conduction time, sinus node recovery time). The same tests were carried out in 19 patients without sinus node dysfunction (Group B). In the latter group, sinus rhythm exceeded 80/min during right ventricular pacing at 150/min and the rate increased with respect to the basal rhythm was always greater than 10/min. In Group A premature atrial pacing gave abnormal results in 4 cases, sinus node recovery times were abnormal in 15 cases, and rapid right ventricular pacing abnormal in all cases (sinus rhythm less than 80/min and/or rate increase of less than 10/min). There was no relation between the increased sinus node recovery time and the degree of rate increase during rapid ventricular pacing. Incremental right ventricular pacing, therefore, seems to be a new method of investigating sinus node function but complementary studies are required to determine its limitations, the exact mechanism and to try to widen its application to subjects without ventriculo-atrial block.

Aged↗
PubMed1982

Holter monitoring in the complex analysis of sinus node dysfunction.

To study the diagnostic possibility and the mechanisms involved in sinus node dysfunction, 23 patients with sick sinus syndrome were evaluated by the basic electrophysiological method (recovery times, secondary postpacing phases, sinoatrial conduction times) before and after pharmacologic autonomic blockade with i.v. propranolol 0.2 mg/kg and atropine 0.04 mg/kg, and by continuous rhythm monitoring. Patient groups of normal (I) and pathological (II) intrinsic heart rate (IHR) were compared. In group I (no. 15) prolonged recovery time (2/15), postpacing sinoatrial-block (1/15) and chaotic postextrasystolic patterns (5/15) ceased after autonomic blockade; we obtained normal intrinsic recovery time, gradual return to the stable intrinsic sinus cycle length in the secondary phase, and a normal intrinsic sinoatrial conduction time. In group II (no. 8) during the control study only 50% of patients had pathological electrophysiological parameters before, and 100% after the drug test (no gradual postpacing return to the intrinsic heart rate, abnormal recovery times, abnormal sinoatrial conduction times or chaotic postextrasystolic patterns). Holter monitoring revealed significant differences between the minimal heart rate during sleeping (group I: 48 +/- 10 bpm, mean +/- SD group II: 32 +/- 4 bpm, probability less than 0.001) as well as in the average sinus cycle length for 24 hours (group I: 848 +/- 88 ms, group II: 1254 +/- 136 ms, P less than 0.001) with a very characteristic histogram. In the patients with pharmacologically and electrophysiologically documented abnormal intrinsic rhythmicity (group II), the first 24 hour Holter monitoring revealed positive ECGs for sinus node dysfunction. In patients with normal intrinsic electrophysiological sinus node properties (group I) repeated continuous rhythm recordings revealed severe sinus bradycardia (1 patient), sinoatrial-block (1 patient), tachybrady syndrome (1 patient) and sinus-arrest (2 patients, up to 29 120 ms in waking period). These findings suggest that 1) IHR is the best and simplest diagnostic method of intrinsic sinus node dysfunction (in patients of abnormal low IHR we found positive electrophysiological and Holter parameters), and 2) in autonomic sinus node dysfunction electrophysiological parameters are essentially negative showing normal intrinsic sinus node function; in these patients systematically repeated Holter monitoring is the most valuable diagnostic method.

Adult↗
PubMed1981

[The effects of digoxin administration on normal and pathological sinus node function. An electrophysiological study (author's transl)].

In 12 normal subjects (group I), in 12 subjects with asymptomatic sinus bradycardia (group II) and in 18 patients with symptomatic sick sinus syndrome (group III), sinus node cycle length (SNCL), sinus node recovery time (SNRT), corrected sinus node recovery time (CSNRT), sino-atrial conduction time (SACT), have been evaluated before and after an acute digoxin administration. Mean value of SNCL lengthened significantly in all groups. Mean value of SNRT increased moderately in the first group, remarkably in the third group, whereas it showed a mild but statistically insignificant increase in the second group. Mean value of CSNRT was significantly lengthened only in the third group. Mean value of SACT showed a mild but statistically insignificant lengthening in all groups. In order to investigate the importance of the parasympathetic action induced by digitalis, in 4 normal subjects, in 4 patients with asymptomatic sinus bradycardia, and in 10 patients with symptomatic sick sinus syndrome, SNCL, CSNRT and SACT has been evaluated after an intravenously, administration of atropine, following digoxin. In the paper the intricate mechanisms by which digitalis affects the parameters of sinus nodal function especially in patients with symptomatic sick sinus syndrome, are discussed. In disagreement with the mot papers reported in the literature we think that an acute digoxin administration is able to worsen the electrophysiological parameters of sinus nodal function especially in patients with symptomatic sick sinus syndrome.

Adult↗
PubMed1995

Bacteriology of maxillary sinuses in rabbits.

To study whether normal sinus flora exist in normal sinus, we used 40 sinuses from 20 New Zealand white rabbits as the animal model. The histological examination was performed on sinus mucosa from each sinus and bacteria from these sinuses were cultured. Surprisingly, 70% of them (28 sinuses) were found to have sinusitis. These sinuses not only contained bacteria in culture but also showed various degree of histological inflammatory reaction in mucosa examination. Of the other 12 normal or near normal sinuses, only two showed positive bacterial culture, and ten of them showed negative bacterial culture either from discharge or mucosa studies. Accordingly, these data suggest that these two studies (bacterial culture and histological mucosa examination) are consistent. Thus, from this study it was concluded that there is no bacteria or few bacteria in normal sinus.

Animals↗
PubMed1993

[Iatrogenic sinus node disease and iatrogenic AV block].

The appearance of long lasting bradycardia due to damage of the sinus node (iatrogen sick sinus syndrome; or the atrioventricular conduction system, iatrogen AV block) is not a rare event after open heart surgery. In the course of 5093 heart operations the development of iatrogen sick sinus syndrome was observed in 234 patients (4.6%) and iatrogen AV block in 91 cases (1.8%). The incidence rate of iatrogen sick sinus syndrome or iatrogen AV block was quite divergent depending mostly on the type of operation. Comparing the data of our earlier (1977-1982) and later (1983-1991) cardiac surgical interventions, the prevalence of iatrogen sinus node disease and iatrogen AV block seems to decrease, mainly due to the progress in techniques of cardiac surgery. With the appearance of iatrogen sick sinus syndrome or AV block, urgent temporary pacing is indicated to prevent the deleterious hemodynamic effect of bradycardia. In the cases of persistent iatrogen sick sinus syndrome and iatrogen AV block, permanent pacemaker implantation is needed. It is remarkable that although the incidence rate of iatrogen sick sinus syndrome is greater than that of iatrogen AV block, in iatrogen sick sinus syndrome the regression is quite frequent, while in iatrogen AV block the 2nd or 3rd degree AV block is usually permanent. We performed pacemaker implantation in 56 cases of iatrogen sick sinus syndrome (24%) and in 57 patients of iatrogen AV block (63%). With pacemaker therapy the outcome of iatrogen sick sinus syndrome and iatrogen AV block is very favourable.

Bradycardia↗
PubMed1988

Sinusitis in children.

Sinusitis is common in allergic children. We are now aware that the commonest presentation of this disorder in the pediatric age group is persistent cough and purulent rhinorrhea. Headache and facial tenderness, frequently noted in adults with sinusitis, are not common. Much remains to be learned about diagnostic techniques and therapy of sinusitis. Nasal cytology can be valuable for discriminating between allergic and infectious disease, but lacks both sensitivity and specificity. Although there is a high correlation between radiographs showing significant sinus membrane thickening or clouding and recovery of bacteria from antral taps, it is possible to see positive films in asymptomatic individuals. Similarly, films may be unremarkable, although the history and physical examination yield convincingly positive evidence for sinus infection. The clinician must sometimes decide on therapy when the diagnosis is not definitive. Antimicrobial therapy for sinusitis should be given for 3 to 4 weeks in many cases. Amoxicillin remains a good choice for therapy, but antibiotics capable of clearing infections by beta lactamase-producing bacteria should be considered in refractory situations. The value of antihistamines, decongestants, nasal steroids, and cromolyn sodium are unstudied at this time. If several antibiotic courses fail to alleviate the signs and symptoms of sinusitis, surgery is indicated. Antral lavage and creation of nasoantral windows is the usual approach in children. Patients with sinusitis often have concurrent middle ear disease. Patients with current sinusitis have a higher incidence of immunoglobulin disorders than found in a normal pediatric sample. It appears that patients with sinusitis are more often allergic than would be expected from 2 typical population distribution. More evaluation is needed to clarify these associations.

Amoxicillin↗
PubMed2001

Complementary role of MR imaging of ethmomaxillary sinus disease depicted at CT in cystic fibrosis.

PURPOSE: To assess whether MR imaging can improve characterization of ethmomaxillary opacification diagnosed at CT in patients with cystic fibrosis (CF) in order to select patients that may benefit from functional endoscopic sinus surgery (FESS). MATERIAL AND METHODS: Sixty-two CF patients (26 females and 36 males) aged 4-50 years (median 20 years) with ethmomaxillary sinus disease at CT underwent MR examination of the paranasal sinuses (coronal T1 and STIR sequences). FESS had been performed in 28 of the patients prior to this study. MR signal intensities were interpreted as mucosal thickening or infectious material, according to a previous study. RESULTS: Three major maxillary sinus MR patterns could be distinguished: Air-filled, oval-shaped pus-filled, and streaky-shaped pus-filled sinus lumen. For air-filled maxillary sinuses with mucosal thickening, CT and MR imaging were diagnostically equivalent. Where CT showed homogeneous opacification of the maxillary sinuses, MR imaging differentiated between thickened mucosa and pus-filled areas. Patients who had undergone FESS most commonly had air-filled or streaky-shaped pus-filled maxillary sinus lumen. In non-operated patients oval-shaped pus-filled sinus lumen was most common and could occur without ethmoid disease. CONCLUSION: MR imaging of the paranasal sinuses can differentiate between infectious material and thickened mucosa and should be used to select CF patients with pus-filled areas that can be eradicated with FESS.

Adolescent↗
PubMed1996

[Endonasal endoscopic ethmoidectomy in acute therapy refractory sinusitis].

BACKGROUND: Acute sinusitis usually requires conservative treatment with antibiotics and decongestion nose drops. However, a certain number of cases do not respond to that treatment. Because functional endoscopic endonasal sinus surgery (FESS) has been proven to be a valuable tool in treatment of all kind of chronic sinus diseases, it was adopted for acute complicated sinusitis. METHODS: Between 1990 and 1993, ethmoidectomy was performed in 43 patients with acute inflammatory sinus disease in whom conservative treatment had failed (frontal sinusitis n = 11, max. sinusitis n = 10, isolated ethmoiditis n = 5, orbital complications of sinusitis n = 10, sphenoidsinusitis n = 2, acute pyomucocele n = 5). Coronal CT scan revealed mucosal pathology of the ethmoid region in 41 cases. None of the patients had intranasal polyposis. Complete ethmoidectomy was performed under general anesthesia using an endoscope and the transnasal route. RESULTS: All patients had relief of their symptoms within the first two postoperative days. One patient with a mucocele and two patients with orbital complications following osteoplastic procedures required revision surgery for removal of screws and plates from previous surgery. None of the patients developed recurrent symptoms of acute complicated sinusitis within the mean postoperative observation period of nine months. CONCLUSION: FESS should early be considered as a possible treatment of acute sinusitis and its complications if conservative treatment fails.

Acute Disease↗
PubMed1998

Acute sinusitis in the rabbit model: histologic analysis.

OBJECTIVES: Characterize the histology of the rhinogenic model of sinusitis and compare this with existing models of sinusitis. STUDY DESIGN: Prospective controlled trial in animals. METHODS: New Zealand white rabbits were implanted with a synthetic sponge, which was then impregnated with Streptococcus pneumoniae bacteria. After a specified time the animals were sacrificed, and whole-mount sectioning of both the infected and noninfected sinuses was performed. The sinuses were carefully examined for evidence of inflammatory changes. RESULTS: This model produced a sinus infection that is characterized by luminal exudates of neutrophils and eosinophils, mucosal infiltration with lymphocytes and plasma cells, and epithelial degeneration. In addition, discrete lymphoid follicles were identified in both the implanted and nonimplanted sides that in the implanted sides appear to hypertrophy and liberate leukocytes into the sinus lumen. Other areas were observed where luminal exudates seem to act on and degrade mucosa that has little or no underlying inflammation. In severely infected sinuses submucosal vacuole formation with overlying granulation tissue was observed. CONCLUSIONS: The rhinogenic model of sinusitis demonstrates features typical of other known models of sinusitis. In addition, there appear to be unique features of this model, specifically the identification of discrete lymphoid aggregates, which suggest that this model has the potential to be valuable for the study of the immune response of the sinuses.

Acute Disease↗
PubMed1999

The hypoplastic inferior petrosal sinus: a potential source of false-negative results in petrosal sampling for Cushing's disease.

Our purpose was to describe the hypoplastic or plexiform inferior petrosal sinus as a potential cause of false-negative sampling results in patients with Cushing's disease. Five hundred and one patients with surgically proven Cushing's disease and negative or equivocal magnetic resonance imaging scans of the pituitary gland underwent petrosal sinus sampling. Four patients (0.8%) with surgically proven Cushing's disease had false-negative results of petrosal sinus sampling. Retrograde inferior petrosal sinograms in these patients were reviewed to evaluate the anatomy of the inferior petrosal sinuses for abnormalities that could have contributed to this misdiagnosis. In addition, the retrograde inferior petrosal sinograms of 100 consecutive patients were reviewed to establish the frequency of asymmetric and/or hypoplastic inferior petrosal sinuses. All four patients with false-negative results of petrosal sampling demonstrated a hypoplastic or plexiform inferior petrosal sinus ipsilateral to an ACTH-secreting microadenoma. When the sampling catheter was in the hypoplastic petrosal sinus, retrograde sinograms from the contralateral side demonstrated anomalous drainage patterns on the side of the hypoplastic sinus. Because the negative results of petrosal sinus sampling false-suggested the presence of the ectopic ACTH syndrome, curative transsphenoidal surgery in these four patients was delayed up to 31 months. We conclude that the presence of a unilateral hypoplastic or plexiform inferior petrosal sinus can result in anomalous drainage from the pituitary gland that may lead to false-negative sampling results in patients with Cushing's disease.

Adolescent↗
PubMed1989

[Maxillary sinus by waters' view-superimposed structures].

The image of the maxillary sinus obtained by Waters' view contains such superimposed structures as lateral extensions of the sphenoidal sinus and posterior ethmoidal cells. Planimetric evaluations were done for the maxillary sinus itself and the two superimposed sinuses. The medial portion of maxillary sinus is occupied by these two sinuses and the areas covered by these amount to one third of the maxillary sinus' area. To properly interpret the radiolucency of the maxillary sinus, the areas covered by these two sinuses and the areas corresponding to the zygomatic recess should be avoided. The proper radiolucency of the maxillary sinus should be evaluated at the central portion, namely at and around the point where the vertical line passing the inferior orbital canal and the horizontal line passing the foramen rotundum meet each other.

Biometry↗
PubMed1999

Persistent perineal sinus after proctocolectomy for Crohn's disease.

PURPOSE: Persistent perineal sinus is a source of morbidity after proctocolectomy for Crohn's disease. This study examined the factors responsible for persistent sinus after proctocolectomy for Crohn's disease. We also assessed the outcome of surgical treatment for persistent perineal sinus. METHODS: The records of 145 patients who underwent proctocolectomy for Crohn's disease between 1970 and 1997 were reviewed. RESULTS: Persistent sinus occurred in 33 (23 percent) patients after proctocolectomy. Factors associated with a significantly greater risk of perineal sinus were younger age (P = 0.006), rectal involvement (P = 0.02), perianal sepsis (P = 0.0005), high fistulas (P = 0.04), extrasphincteric excision (P = 0.0004), and fecal contamination at operation (P = 0.0003). Multivariate analyses showed that age (P = 0.0001), rectal involvement (P = 0.007), and fecal contamination (P = 0.009) were significant independent predictive factors for perineal sinus. Fifty-six operations, including 24 radical excisions, two rectus abdominis flaps, four gracilis transpositions, and two omentoplasties were performed in 24 patients with persistent sinus, but only 9 achieved healing. Long sinuses (>10 cm) and sinuses presenting late (>12 weeks after proctocolectomy) were seldom cured by surgical treatment. CONCLUSION: Persistent perineal sinus is more likely to occur if an extrasphincteric dissection is needed because of extensive anorectal disease or if fecal contamination occurs at operation. Attempted surgical eradication of perineal sinus is often ineffective.

Adrenal Cortex Hormones↗
PubMed1983

Sinus node recovery times following the spontaneous termination of supraventricular tachycardia and following atrial overdrive pacing: a comparison.

We compared the pauses that followed the spontaneous termination of supraventricular tachyarrhythmias with the pauses that followed the cessation of atrial overdrive pacing in 21 patients. In 10 patients with abnormal sinus node function and in 11 patients with normal sinus node function we recorded the spontaneous termination of supraventricular tachyarrhythmia in the clinical electrophysiology laboratory; a strong correlation (r = 0.94) was found between the maximal spontaneous sinus node recovery time and the maximal paced sinus node recovery time. A weaker correlation was found between the paced and spontaneous sinus node recovery times (r = 0.57) when the spontaneous termination of supraventricular tachyarrhythmia was recorded during ambulatory electrocardiographic recording in seven patients. Spontaneous sinus node recovery times were significantly shorter than maximal paced sinus node recovery times (p less than 0.001). However, no significant difference was detected between the paced and spontaneous sinus node recovery times when atrial pacing was performed at the rate of the tachycardia. We conclude that spontaneous and postpacing sinus node recovery times are closely correlated. The paced sinus node recovery time is, however, frequently more prolonged than spontaneous sinus node recovery time because of probable atriosinus entrance block during rapid supraventricular tachycardia.

Adult↗