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At least 19 recordsLinked to original sources
PubMed1992

Shifting of dural arteriovenous malformation from the cavernous sinus to the sigmoid sinus to the transverse sinus after transvenous embolization. A case of left spontaneous carotid-cavernous sinus fistula.

The angiographic features of left spontaneous carotid-cavernous sinus fistula and multiple dural arteriovenous malformations that developed after transvenous embolization are described. A dural arteriovenous malformation involving the left sigmoid sinus was demonstrated, along with a marked decrease in size of the left carotid-cavernous sinus fistula and the disappearance of venous drainage from the left cavernous to the right cavernous sinus after embolization with spring coils via the left superior ophthalmic vein. The dural arteriovenous malformation of the left sigmoid sinus subsequently extended to the transverse sinus after partial embolization of the sigmoid sinus. Finally, a dural arteriovenous malformation involving the left transverse sinus developed, with the disappearance of the arteriovenous malformation affecting the sigmoid sinus and left carotid-cavernous sinus fistula following complete embolization of the sigmoid sinus via the left transverse sinus.

Adult↗
PubMed1982

[Reproducibility of electrophysiological tests of sinus node function in patients with sick sinus syndrome. Reproducibility of tests of sinus node recuperation time, corrected sinus node recuperation time and sino-atrial conduction time].

In order to clarify whether SNRT, CSNRT and SACT are reproducible tests, 20 patients with sick sinus syndrome underwent two successive electrophysiological studies with an interval of 24 hours; mean sinus cycle, SACT, SNRT, CSRNT were evaluated. Although no significant differences were found between the mean values of the two studies, in isolated cases remarkable variations of one or more parameters were observed. We conclude that SNRT, CSNRT and SACT are reproducible tests only if mean values in a large number of patients are considered, while they are not as useful in quantifying sinus node dysfunction in single cases. In conclusion, while SNRT, CSNRT and SACT are reproducible and useful in comparing data from relatively large number of patients, great caution should be used before drawing conclusions of potentially serious diagnostic and prognostic consequence in the single patient.

Aged↗
PubMed1998

Comparison of inflammatory cell profile and Th2 cytokine expression in the ethmoid sinuses, maxillary sinuses, and turbinates of atopic subjects with chronic sinusitis.

Chronic sinusitis is a common disease characterized by persistent inflammation of the sinus mucosa. This study was undertaken to investigate immunopathologic findings in biopsy specimens from the ethmoid sinuses, maxillary sinuses, and inferior nasal turbinates of 14 allergic subjects with chronic sinusitis. The composition of the inflammatory infiltrate in the three tissue sites was examined by immunocytochemistry with anti-CD3 (total T cells), anti-CD4 (helper T cells), anti-CD8 (suppressor T cells), anti-MBP (eosinophils), antitryptase (mast cells), and antichymase (mast cells) antibodies. These revealed a significant increase in the T-cell helper/suppressor ratio and eosinophils in the ethmoid sinus mucosa compared with those in the maxillary sinus mucosa and the inferior turbinate. Eosinophil numbers were also higher in the maxillary sinus than in the inferior turbinate. Mast cells were present in significantly higher numbers in the ethmoid sinus and inferior turbinate biopsy sections than in the maxillary sinus. With antisense, radiolabeled riboprobes, we used in situ hybridization to examine the expression of interleukin-4 and interleukin-5 transcripts. The density of cells expressing interleukin-4 transcripts was significantly higher in the inferior turbinate biopsy sections than in those from the ethmoid and maxillary sinuses. In addition, the number of interleukin-4 mRNA-positive cells was higher in the ethmoid than in the maxillary sinus mucosa. The density of interleukin-5 mRNA-positive cells was significantly higher in the ethmoid and maxillary sinuses than in the inferior turbinate. The results of this study indicate (1) a more intense inflammatory response in the ethmoid sinus than in the maxillary sinus and inferior turbinate in allergic chronic sinusitis and (2) different inflammatory responses in the upper airways that are dependent on the anatomic site. These findings have potential implications in the design of new therapeutic interventions for allergic chronic sinusitis.

Adolescent↗
PubMed1989

The duration of the sinus node depolarization on transvenous sinus node electrograms can identify sinus node dysfunction and can suggest its severity.

Catheter recorded sinus node electrograms (SNE) allow visualization of sinus node depolarization (SND). The SND on a bipolar SNE is probably a composite reflecting both P cell action potentials and intranodal conduction. Reduced rate of rise, prolonged action potential duration and/or delayed intranodal conduction might each prolong the SND duration. Thus, SND duration might reflect several clinically important sinus node abnormalities and aid in the recognition of sick sinus syndrome. Moreover, the SND duration might be expected to be the most prolonged in patients with the most severe sinus node dysfunction. To test this hypothesis, we determined SND duration in 32 patients and correlated it with the presence or absence of evidence of sinus node dysfunction by ECG and/or electrophysiological (EP) studies. Seven patients had no sinus node dysfunction (group 1); 10 patients had mild sinus node dysfunction (a single abnormality of corrected sinus recovery time, sinoatrial conduction time, PCLp, or ECG) (group 2); and 15 patients had two or more abnormalities electrocardiographically and/or by EP testing (group 3). The SND duration (mean/range) was 129/95-190 msec in group 1, 151/95-225 msec in group 2, and 196/140-260 msec in group 3. In group 3, three patients who had ECG evidence of sick sinus syndrome and abnormalities on all three EP parameters, the SND duration was 230/200-260 msec. Carotid sinus massage (CSM) was found to prolong the SND duration in 5/7 patients in groups 2 and 3 where the SND could be measured both before and during CSM. CSM was necessary to allow visualization of the SND in 3/7 group 1 patients; thus their recorded values may be falsely long. The normal with a SND duration greater than 150 (190 msec) had it measured during CSM. None of the group three patients with SND duration less than msec had a prolonged CSRT or ECG evidence of sick sinus syndrome. Literature review revealed SNE recordings on 18 patients with sick sinus syndrome on which the SND duration could be measured; it was greater than or equal to 200 msec in all. Thus, the SND duration appears to reflect the presence and degree of sinus node dysfunction. Sinus node dysfunction appears unlikely if the SND duration is less than 150 msec and is likely to be severe if the SND duration is greater than 200 msec.

Adult↗
PubMed1997

Radical resection of meningiomas and arteriovenous fistulas involving critical dural sinus segments: experience with intraoperative sinus pressure monitoring and elective sinus reconstruction in 10 patients.

OBJECTIVE: Radical resection of meningiomas and dural arteriovenous fistulas involving functional major dural sinuses entails the risk of intracranial hypertension and venous infarction. Surgical reconstruction of dural sinuses and bridging veins increases the spectrum of dural sinus conditions that can be treated by complete resection, but indications for venous reconstructions and associated risks are still not well defined. We report our experience with sinus reconstruction based on the intraoperative assessment of collateral venous flow. METHODS: Radical resection of meningiomas (n = 5) or dural arteriovenous fistulas (n = 5) involving critical segments of dural sinuses was performed in 10 patients. All but two patients were suffering from recurrent disease after incomplete treatment. Tolerance of sinus occlusion was assessed intraoperatively by measuring stump pressure in the superior sagittal sinus during test clamping of the involved sinus segment. RESULTS: In five patients, the results of pressure monitoring suggested that occlusion of the sinus might not be tolerated. In two other patients, major bridging veins entered the diseased segment. In these patients, the resected sinus segment was reconstructed and bridging veins were reinserted as far as possible. Postoperative graft occlusion occurred in two patients. One patient who was managed without reconstruction sustained a transient postoperative neurological deficit resulting from venous congestion in the vein of Labbé. Postoperative imaging confirmed total elimination of the pathological process in all 10 patients. There was no recurrence of disease during follow-up periods of up to 8 years. CONCLUSION: The monitoring of sinus pressure, together with the possible reconstruction of the diseased sinus, allows complete surgical treatment of dural sinus abnormalities and involves acceptable risk.

Adolescent↗
PubMed1984

[Influence of beta block and autonomic nerve block on the recovery time of the sinus node in sick sinus syndrome and carotid sinus syndrome].

In order to evaluate the relative role of the automatic nervus system and of the intrinsic electrophysiologic properties on the sinus node function, we measured the corrected sinus node recovery time before and after autonomic nervous system blockade in 24 patients. Fourteen had a sick sinus syndrome, five had a carotid sinus syncope, two had syncope of unknown origin associated with bradycardia. Beta blockade was obtained by infusing metoprolol intravenously at a dosage of 0.2 mg/kg; complete automatic blockade was achieved by further i.v. administration of atropine at a dosage of 0.04 mg/kg. After beta blockade, the corrected sinus node recovery time increased in patients with sick sinus syndrome and intrinsic slow heart rate, whereas it decreased in patients with carotid sinus syncope or with syncope and bradycardia. In patients with sick sinus syndrome and normal intrinsic heart rate the response was variable. A positive direct correlation was found between the changes of the corrected sinus node recovery time induced by beta blockade and those induced by autonomic blockade; that is, both either prolonged or shortened the corrected sinus node recovery time. The changes of the corrected sinus node recovery time after beta blockade alone were inversely correlated with the intrinsic heart rate. We conclude that patients with intrinsic depression of the sinus node have an increased sympathetic tone.

Adult↗
PubMed2002

[Evaluation of B-scan ultrasound, 3-D ultrasound, roentgen diagnosis and sinus endoscopy in follow-up assessment of the maxillary sinus after sinus floor elevation].

PROBLEM: The aim of this study was to determine which technique--B-scan sonography, 3D sonography, X-ray, or endoscopy--is the most effective for diagnosis in changes of the maxillary sinus after sinus lift and simultaneous augmentation. MATERIAL AND METHODS: In 33 patients the maxillary sinus was examined before sinus lift, 1 week and 6 months postoperatively with a 7.5-MHz linear scanner and 3D sonography. At the same time, the sonographic results were compared with the X-ray as well as the endoscopic results. Endoscopy of the maxillary sinus was only applied during the sinus lift operation and the abutment operation after 6 months. RESULTS: A total of 56 operations of sinus lift and simultaneous augmentation with autogenous bone were carried out. Preoperatively, there where no pathological findings detectable in the maxillary sinus. One week postoperatively, the X-rays as well as the sonographic images revealed thickening of the mucosa in 40 maxillary sinuses. After the healing period of 6 months, polyposa was still detected in three cases sonographically, in the radiographic follow-up as well as endoscopically. The sonographic 3D imaging of the maxillary sinus improved the spatial visualization of postoperative changes in the maxillary sinus and the reliability of the diagnosis. CONCLUSION: Due to the lack of radiation, the cost effectiveness, and its reproducibility, sonography is suitable as a primary screening technique in recall. In cases of normal sonographic findings but clinical symptoms, CT, MRT, and endoscopy should be performed to exclude pathological processes of the posterior maxillary sinus.

Alveolar Ridge Augmentation↗
PubMed1997

Efficacy of sinus irrigation versus sinus irrigation followed by functional endoscopic sinus surgery.

Sinus irrigation is the traditional treatment for chronic maxillary sinusitis. Functional endoscopic sinus surgery (FESS) restores aeration and allows secretions to be removed from an infected sinus. This study compares the efficacy of sinus irrigation with that of sinus irrigation followed by FESS in 89 patients. We measured the effects by way of sinus radiographs, nasendoscopic findings, and patient complaints. When we analyzed the data in terms of intent to treat, we found significantly favorable results for sinus irrigation followed by FESS at the end point, though only for loss of smell and purulent rhinitis. Treatment consisting of sinus irrigation alone prevented surgery in 58% of all patients for 1 year. Both treatment methods were combined with a 10-day course of loracarbef, which might have contributed to the outcome. We conclude that a good option for treatment of chronic maxillary sinusitis seems to be sinus irrigation in combination with a broad-spectrum antibiotic followed by FESS.

Adult↗
PubMed1979

Effects of digoxin on sinus nodal function before and after vagal blockade in patients with sinus nodal dysfunction: a clue to the mechanisms of the action of digitalis on the sinus node.

To increase the limited knowledge of the effects of digitalis on sinus nodal function in patients with sinus nodal dysfunction and to initiate an investigation into the mechanisms underlying its effects, 34 patients with sinus nodal dysfunction were studied. Twenty patients underwent determination of sinus cycle length, estimated sinoatrial conduction time and maximal corrected sinus recovery time before and after the administration of 0.75 mg of intravenous digoxin. For the group, sinus cycle length did not change, sinoatrial conduction time increased insignificantly and maximal corrected sinus recovery time shortened; however, individual variation occurred. The effects of acute digitalization appeared to predict the effects of chronic digitalis administration on sinus nodal function in the eight patients who subsequently continued to take digoxin. Fourteen patients received digoxin after vagal blockade with atropine. After vagal blockade, digoxin lengthened sinus cycle length, sinoatrial conduction time and maximal corrected sinus recovery time. The effects of digoxin administered after atropine could be antiadrenergic, direct, or both, and are opposite to those induced by atropine alone. Because these effects are similar to those of vagotonia yet are not apparent when the vagi are unblocked, digoxin may have direct excitatory, adrenergic or previously unrecognized vagolytic effects on sinus nodal function in man and their manifestation may be dependent on heart rate or autonomic tone.

Adult↗
PubMed1990

[Clinical feature of odontogenic maxillary sinusitis--symptomatology and the grade in development of the maxillary sinus in cases of dental maxillary sinusitis].

Odontogenic maxillary sinusitis may occur by draining of an apical dental root abscess into the maxillary sinus. It has been reported that the disease is usually frequent in cases aged of the second and third decades. In most of them, either the first or second molar tooth is assumed to be the origin of the disease. As clinical characteristic symptoms, it is mentioned that an acute unilateral sinusitis appears since the onset and the patient complains a fetid purulent nasal discharge from an early stage. The symptom and its clinical time course in 43 cases with dental maxillary sinusitis, who had been treated by surgical procedures in ENT Clinic in Kitasato University Hospital during past 14 years from 1972 to 1985, were studied retrospectively. The size of the affected maxillary sinus in each case of the disease was measured from the X-ray films. An influence of development of the maxillary sinus to the occurrence of dental sinusitis was discussed by comparing the sizes of the maxillary sinuses in both the group of the disease and the group of simple unilateral maxillary sinusitis.

Adolescent↗
PubMed1993

[Endoscopic paranasal sinus surgery. The most important anatomic variations of the main paranasal sinus and accessory paranasal sinus].

Anatomic variations of the nasal cavity and paranasal sinuses are described in order of their appearance in endoscopy. Variations of the pyriform aperture are followed by variations of the agger nasi, inferior and middle conchas, inferior and middle nasal meati, and variations of the bulla ethmoidea, uncinate process and fontanelles. Variations of the maxillary sinus are described from their anterior and lateral views. Partial and total septation of the maxillary sinus, variations of its dimensions and its relation to dental roots are stressed. The dimensions of the frontal sinus, frontal bulla or bullae are noted. The variation of the sphenoid sinus and its dimensions and relationships to the structures of the cavernous sinus and the endocranium are described. Pneumatization of the anterior clinoid process and the region around the optic canal by the frontal sinus, ethmoid labyrinth or sphenoid sinus is discussed. Knowledge of these different variations will help the rhinologic surgeon in his orientation during endoscopic surgical interventions.

Adolescent↗
PubMed1990

Papillary carcinoma of the sphenoid sinus associated with sphenoid sinus abscess presenting as cavernous sinus syndrome. A case report.

Primary carcinoma of the sphenoid sinus is a rare tumor that may present with dramatic neuro-ophthalmological-symptoms and signs of which spheno-cavernous syndrome is the best known clinical entity. The most frequently encountered histological types of the sphenoid carcinomas are squamous cell carcinoma and papillary carcinoma, in decreasing order of frequency. In this article, a papillary carcinoma of the sphenoid sinus associated with sphenoid sinus abscess is presented. We are not aware of previously reported papillary carcinoma of the sphenoid sinus associated with sphenoid sinus abscess presenting as a cavernous sinus syndrome.

Abscess↗
PubMed1995

Amoxicillin concentrations in nasal secretions of patients with acute uncomplicated sinusitis and in paranasal sinus mucosa of patients with chronic sinusitis.

In this prospective randomized clinical study a total of 59 patients of both sexes (above 18 years of age) were enrolled. Thirty patients with acute sinusitis were randomly allocated to two treatment groups, one group receiving 1000 mg amoxicillin every 12 h for 10 days and the other group receiving 500 mg amoxicillin every 8 h for 10 days. The median concentration of amoxicillin in nasal secretions was 2.34 micrograms/ml in the 12-h administration group and 1.95 micrograms/ml in the 8-h administration group. Median bioavailability of antibiotic at 8-24 h did not show any statistical differences between the two treatment schemes [probability (Z) = 0.2]. Twenty-nine patients with chronic sinusitis were then randomly allocated to three groups, with patients receiving 1000 mg amoxicillin at 12, 8 or 6 h before nasal and/or sinus surgery was carried out. The mean amoxicillin concentrations in mucosal tissues removed intraoperatively ranged from 0.69 to 0.99 microgram/g samples. Statistical evaluation by analysis of variance did not show any statistically significant differences among the three treatment groups [probability (F) = 0.1705]. In all cases of acute and chronic sinusitis, amoxicillin concentrations exceeded minimum inhibitory concentration values for pathogens common in sinusitis. Our results indicate that 1000 mg amoxicillin administered twice daily produces tissue concentrations high enough to be clinically effective in patients with either acute or chronic sinusitis.

Acute Disease↗
PubMed1985

Sinus node echoes and concealed concealed conduction: additional sinus node phenomena confirmed in man by direct sinus node electrography.

Direct sinus node electrography has been previously used to assess several aspects of sinus node physiology: sinus node pauses, overdrive suppression, sinoatrial entrance block. This report presents data in which sinus node electrograms confirm two additional physiologic phenomena in man: concealed conduction in the sinoatrial junction and sinus node reentry. These findings verify the presence of previously suspected phenomena by careful deductive analysis of electrocardiographic and electrographic tracings.

Adult↗
PubMed1996

Value of sinus radiographs in the diagnosis of maxillary sinus disease: interobserver agreement on sinus radiographs by otolaryngologists and radiologists.

Variability between observers and specificity of sinus radiographic findings are subject to discussion. The aim of this study was to assess interobserver variability, between four physicians, two otolaryngologists and two radiologists, in the evaluation of 100 maxillary sinus radiographs. Equal agreement was found within the specialties when rating radiographs as normal or abnormal (80%). Kappa values for interobserver agreement were 0.45 for otolaryngologists and 0.58 for radiologists, both representing fair to good agreement. Otolaryngologists reported more abnormalities (67 vs, 57). Agreement on specific findings (complete opacity, fluid level and mucosal swelling) was fair to good (kappa values between 0.38 and 0.83). Agreement between the four physicians was lower on all outcomes. It is concluded that interobserver variability is within acceptable limits and justifies the continued use of conventional sinus radiographs for confirmation of maxillary sinus disease.

Adult↗
PubMed2001

Digitalis for treatment of congestive heart failure in patients in sinus rhythm.

BACKGROUND: Digitalis glycosides have been in clinical use in the treatment of congestive heart failure for more than 200 years. In recent years several trials have been conducted to address concerns about efficacy and toxicity. Although a systematic review of the literature was recently published, an update is required to include more current trials. OBJECTIVES: To examine the effectiveness of digitalis glycosides in treating congestive heart failure in patients with normal sinus rhythm. To examine the effect of digitalis in patients taking diuretics, ACE inhibitors, and beta blockers; patients with varying severity and duration of disease; patients with prior exposure to digitalis vs. no prior exposure; and patients with diastolic vs. systolic dysfunction. SEARCH STRATEGY: Electronic databases were searched between 1966 and 2000. Dissertation Abstracts and annual meeting abstracts of the American Heart Association, American College of Cardiology, and European Society of Cardiology were searched from 1996-2000. In addition, reference lists provided by the pharmaceutical industry (Glaxo Wellcome Inc.) were searched. SELECTION CRITERIA: Included were randomized placebo-controlled trials of 20 or more adult patients of either sex with symptomatic congestive heart failure who were studied for seven weeks or more. Excluded were trials in which the prevalence of atrial fibrillation was 2% or greater, or in which any arrhythmia that might compromise cardiac function or any potentially reversible cause of heart failure such as acute ischemic heart disease or myocarditis was present. DATA COLLECTION AND ANALYSIS: Articles selected from the searches described above were reviewed by one of the coauthors, and validated by staff from the central office of the Heart Collaborative Review Group in Bristol, UK. MAIN RESULTS: Eleven articles meeting the defined criteria were identified, and major endpoints of mortality, hospitalization, and clinical status, based respectively upon on 8, 4, and 10 of these selected studies, were recorded and analyzed. The data show that there is no difference in mortality between treatment and control groups, whereas digitalis therapy is associated with a lower rate of hospitalization and of clinical deterioration. REVIEWER'S CONCLUSIONS: The literature indicates that digitalis has a useful role in the treatment of patients with congestive heart failure who are in normal sinus rhythm.

Cardiotonic Agents↗
PubMed1995

[Current aspects of frontal sinus surgery. I: Endonasal frontal sinus drainage in inflammatory diseases of the paranasal sinuses].

Most conditions of the frontal sinus requiring surgery can now be managed successfully by endonasal procedures. According to Draf, 3 types of frontal sinus drainage occur. Surgical techniques and indications are described. In a retrospective study we evaluated 132/648 patients who were on average 5 years postoperative. Forty-two patients had type 1, 43 patients had type 2 and 47 patients had type 3 drainage. Endoscopy revealed a normal mucosa in 56-67%, whole polyps were found in 9-15%. There was no recurrence of an orbital or endocranial complication. According to our definition of surgical success, there was a success rate of 83.4% with type 1 drainage, 83.7% with type 2 drainage and 89.4% with type 3 drainage. If there was only little chance for successful endonasal surgery with type 3 drainage, an external osteoplastic frontal sinus operation was performed for definitive therapy.

Drainage↗