1/26. bronchiolitis in Kartagener's syndrome.The association of diffuse bronchiolitis in patients with Kartagener's syndrome (KS) has not been reported previously. The aim of this study was to present the morphological characteristics of bronchiolitis in patients with KS. Eight patients (four males, four females; mean age 37.9 /-18.7 yrs), clinically diagnosed as KS with the classical triad of chronic pansinusitis, bronchiectasis and situs in versus with dextrocardia, were evaluated. Routine chest radiography showed bronchiectasis and dextrocardia in all patients. Chest computed tomography (CT) showed diffuse centrilobular small nodules up to 2 mm in diameter throughout both lungs in six out of eight patients. Pulmonary function tests revealed marked obstructive impairment in all patients (forced expiratory volume in one second 57.0 /-11.3%, residual volume/total lung capacity 45. /-12.7%, maximum midexpiratory flow 0.92 /-0.72 L x s(-1), forced vital capacity 74.1 /-12.2% (all mean /- SD)). The examination of cilial movement of the bronchus revealed immotility in all of the five patients examined. The ultrastructure showed ciliary dynein arm defects in all patients. Histopathological examination of lung specimens obtained at autopsy or by video-assisted thoracoscopic surgery showed obliterative thickening of the walls of the membranous bronchioli with infiltration of lymphocytes, plasma cells and neutrophils, but most of the distal respiratory bronchioli were spared and alveolar spaces were overinflated. Pathologically, the diffuse centrilobular small nodules on the chest CT mainly corresponded to membranous bronchiolitis. This is the first report demonstrating that the association of diffuse bronchiolitis might be one of the characteristic features of the lung in Kartagener's syndrome.- - - - - - - - - - ranking = 1keywords = sinusitis (Clic here for more details about this article) |
2/26. Intracranial complications of frontal sinusitis in children: Pott's puffy tumor revisited.The objective of the present study is to describe the diagnosis and treatment of intracranial complications of frontal sinusitis (Pott's puffy tumor) in a series of pediatric patients at our institution. A rare entity, Pott's puffy tumor has been reported in only 21 pediatric cases in the literature of the antibiotic era. The hospital records and radiographic files at Rainbow Babies and Childrens Hospital, Cleveland, ohio, USA, over the previous 16 years were retrospectively reviewed in a search for patients with the diagnosis of Pott's puffy tumor, defined as scalp swelling and associated intracranial infection. There were 6 male patients and 1 female patient. Ages ranged from 11 to 18 years (median 14.5 years). Intracranial infections consisted of epidural abscess in 5 patients, subdural empyema in 4 and brain abscess in 1. Intraoperative cultures grew anaerobic organisms in 1 patient, microaerophilic streptococcus in 5 patients, klebsiella species in 1 patient and streptococcus pneumoniae in another. All patients presented with frontal scalp swelling, and other common symptoms included headache, fever, nasal drainage and frontal sinus tenderness. Five patients were treated with antibiotics prior to their presentation. Four patients presented with neurologic decompensation characterized by varying degrees of hemiparesis, obtundation, pupillary dilatation or aphasia. All patients underwent craniotomy and evacuation of the intracranial infection. Even severely impaired patients demonstrated full neurologic recovery. Despite the widespread use of antibiotics, neurosurgical complications of sinusitis continue to occur. A high degree of suspicion, along with prompt neurosurgical intervention and the use of appropriate antibiotics, can result in favorable outcomes in even the sickest patients.- - - - - - - - - - ranking = 26.691905444467keywords = frontal sinusitis, sinusitis, frontal (Clic here for more details about this article) |
3/26. Acute bacterial rhinosinusitis: clinical impact of resistance and susceptibility.Sinusitis is a common disorder associated with notable direct and indirect economic costs. Acute bacterial rhinosinusitis (ABRS) is a relatively poorly defined clinical syndrome characterized by a high spontaneous resolution rate, wide variations in presenting symptoms, and an incomplete understanding of the pathogenesis and clinical course of the disease. streptococcus pneumoniae and haemophilus influenzae are the most common causative pathogens in adult ABRS. A relative lack of bacteriological eradication data compared with other respiratory illnesses, uncertainty on the part of many clinicians as to when to treat, and increasing rates of antimicrobial resistance hamper logical treatment strategies. Because it is impossible to know which cases of ABRS will spontaneously resolve and which will not, antimicrobials are recommended. In general, antimicrobial treatment for ABRS should cover both S. pneumoniae and H. influenzae while considering the risk of infection with resistant organisms. Treatment guidelines for ABRS were developed by the Sinus and Allergy health Partnership in 2000 and were updated in 2004. This article discusses a Sinusitis Therapeutic Outcome Model, a data-driven model used in the development of the treatment guidelines, with respect to different scenarios involving ABRS to illustrate the implications of antimicrobial selection on therapeutic outcome.- - - - - - - - - - ranking = 5keywords = sinusitis (Clic here for more details about this article) |
4/26. The place of Riedel's procedure in contemporary sinus surgery.Many operative procedures have been described to treat frontal sinus disease with varying results. Obliteration of the frontal sinus is attempted when drainage procedures fail. Most large series of patients undergoing sinus obliteration have reported recurrent disease yet the management of these patients is rarely discussed. We believe Riedel's procedure has an important role in the management of these patients. Riedel's procedure can help eradicate frontal sinus disease and symptoms when drainage and obliteration have failed and where there is persistent disease involving the anterior wall of the frontal sinus or the sinus itself. Whilst cranialization has a role in the removal of the mucosa or contents of the frontal sinus in craniofacial resection, the morbidity associated with it make Riedel's procedure preferable for dealing with chronic infection or locally invasive disease. Riedel's procedure also maintains a barrier in the form of the posterior wall of the frontal sinus and the intracranial contents. Post-operative disfigurement, the main criticism of this procedure, can be reduced to some extent by chamfering the margins of the frontal sinus along with the supraorbital rims and reconstructing the anterior wall at a later date if necessary. The authors are aware that any report about frontal sinus surgery should be judged after several years follow-up, and whilst not all these cases have been asymptomatic for a decade, several have been reviewed for many years.- - - - - - - - - - ranking = 0.10686433313943keywords = frontal (Clic here for more details about this article) |
5/26. Suppurative complications of frontal sinusitis in children.A retrospective review of children diagnosed and treated for suppurative complications of paranasal sinusitis was undertaken to describe clinical presentation, microbiology, and treatment. This review includes children with subgaleal abscess and osteomyelitis of the frontal bone, subdural empyema, frontal lobe abscess, meningitis, and encephalitis. staphylococcus aureus and group C beta-hemolytic Streptococcus were isolated agents. All children were treated with intravenous antibiotics with drainage of both the sinus and extracranial and intracranial suppurations. Results of treatment in the series support the opinion that combined aggressive surgical and antibiotic treatment is a preferred method in complicated sinusitis in children.- - - - - - - - - - ranking = 22.558867572231keywords = frontal sinusitis, sinusitis, frontal (Clic here for more details about this article) |
6/26. Demonstration of biofilm in human bacterial chronic rhinosinusitis.BACKGROUND: Bacterial biofilms may explain why some patients with bacterial chronic rhinosinusitis (CRS) improve while on antibiotics but relapse after completion of the antibiotic. In the human host, biofilms exist as a community of bacteria surrounded by a glycocalyx that is adherent to a foreign body or a mucosal surface with impaired host defense. biofilms generate planktonic, nonadherent bacterial forms that may metastasize infection and generate systemic illness. These planktonic bacteria are susceptible to antibiotics, unlike the adherent biofilm. methods: We reviewed four cases of CRS using transmission electron microscopy (TEM) to assay for typical colony architecture of biofilms. Bacterial communities surrounded by a glycocalyx of inert cellular membrane materials consistent with a biofilm were shown in two patients. RESULTS: In the two patients without biofilm, a nonbacterial etiology was discovered (allergic fungal sinusitis) in one and in the other there was scant anaerobic growth on culture and the Gram stain was negative. Culture of the material from the biofilm grew pseudomonas aeruginosa in both patients. Pseudomonas from the biofilm showed a glycocalyx, not present in Pseudomonas cultured for 72 hours on culture media. Both patients' symptoms with bacterial biofilms were refractory to culture-directed antibiotics, topical steroids, and nasal lavages. Surgery resulted in cure or significant improvement. CONCLUSION: biofilms are refractory to antibiotics and often only cured by mechanical debridement. We believe this is the first TEM documentation of bacterial biofilms in CRS in humans.- - - - - - - - - - ranking = 6keywords = sinusitis (Clic here for more details about this article) |
7/26. AmBisome treatment of fungal sinusitis in severe immunocompromised patient with acute lymphoblastic leukemia relapsed after autologous peripheral blood transplantation.This report describes the case of fungal sinusitis in severely immunocompromised 32-year-old male with common-type acute lymphoblastic leukemia who relapsed after autologous peripheral blood transplantation. Empirical therapy with antibiotics and conventional amphotericin b failed to resolve the infection. Following therapy with AmBisome his symptoms abated and significantly improved scan picture was seen.- - - - - - - - - - ranking = 5keywords = sinusitis (Clic here for more details about this article) |
8/26. Periorbital hematoma secondary to sinusitis in a child.Periorbital abscess secondary to sinusitis is a well-recognized entity in children. However, subperiosteal hematoma is extremely rare and has been reported in only four adult patients. This article presents the case of a 4-year-old girl with sinusitis, proptosis, and decreased visual acuity. Surgical exploration of the orbit revealed the presence of a large organizing subperiosteal hematoma that was drained. The presence of a periorbital hematoma should be suspected in patients with acute onset of proptosis and findings of a periorbital mass and sinusitis on computed tomographic scan.- - - - - - - - - - ranking = 7keywords = sinusitis (Clic here for more details about this article) |
9/26. capnocytophaga infection involving a portal-systemic vascular shunt.capnocytophaga sp., a microaerophilic gram-negative isolate of the human oral cavity, has previously been reported to cause sinusitis, empyema, wound infections, conjunctivitis, subphrenic abscess, osteomyelitis, bacteremia, cervical abscess, and endocarditis. We report the unusual case of infection with this organism at the anastamotic site of a splenorenal portosystemic vascular shunt. In this case, the pathogenesis is presumed to be bacteremia related to mucosal trauma from endoscopic injection sclerotherapy or bacteremia secondary to dental infection. The characteristics and antibiotic sensitivities of capnocytophaga are reviewed.- - - - - - - - - - ranking = 1keywords = sinusitis (Clic here for more details about this article) |
10/26. epidural abscess and subdural empyema.epidural abscess and subdural empyema are serious intracranial infections that result in significant morbidity and mortality. Frequently, they are secondary to sinusitis or middle ear disease, and the bacteria involved are inhabitants of the upper respiratory tract. Symptoms may be mild and mimic the symptoms of the underlying infection. However, especially with subdural empyema, alteration in the level of consciousness and focal neurologic deficits are common. morbidity and mortality are minimized by early diagnosis, which is best made with computed tomography scanning, and proper therapy, which consists of surgical drainage and administration of appropriate antimicrobials. It is important that primary care physicians be aware of the clinical features of these potentially fatal complications of common infections.- - - - - - - - - - ranking = 1keywords = sinusitis (Clic here for more details about this article) |
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