Large prospective validation and cultural adaptation of the Polish version of the Swiss Spinal Stenosis Questionnaire for patients with lumbar spinal stenosis.

OBJECTIVE: The aim of this prospective cohort study was to translate, validate and perform a cultural adaptation of the Polish version of the Swiss Spinal Stenosis Questionnaire (P-SSSQ), a disease-specific questionnaire for assessing symptom severity, physical function and satisfaction with treatment in patients with lumbar spinal stenosis (LSS). MATERIAL AND METHODS: Patients were prospectively recruited at two orthopedic centres in Krakow, Poland, between January 2011 - October 2016. During the interview, each patient completed the P-SSSQ, SF-36 Health Survey, and a demographic data questionnaire. After translation, cross-cultural adaptation, and pilot testing, assessment was made of the internal consistency, test-retest reliability, construct validity, and responsiveness of the P-SSSQ subscales. RESULTS: Finally, 171 consecutive patients were included in the study. Cronbach's alpha and ICC values were above 0.8 for all three subscales of the P-SSSQ. The symptom severity domain was highly negatively correlated with physical functioning and bodily pain of SF-36, with Pearson correlation coefficients of -0.68 and -0.63, respectively. The physical function domain was highly negatively correlated with physical functioning (r = -0.62). The satisfaction subscale was also highly negatively correlated with the change in the symptom severity (r = -0.61) and physical function scale (r = -0.65). CONCLUSIONS: The proposed version of the P-SSSQ showed excellent measurement properties and can be considered validated for use in Polish. It is easy to understand, quick to complete, and the psychometric properties of the original version are maintained.

Validation of the intervertebral disc histological degeneration score in cervical intervertebral discs and their end plates.

BACKGROUND CONTEXT: Vertebral joints consist of intervertebral discs (IVDs) and cartilaginous end plates (EP) that lie superiorly and inferiorly to the IVDs and separate them from the adjacent vertebral bodies. With aging, both IVDs and EPs undergo degeneration. The Histologic Degeneration Score (HDS) is a grading system that microscopically evaluates the degree of degeneration in lumbar discs and predicts it with high accuracy basing on several histological markers of IVD and EP. There is currently a lack of validated histologic grading schemes for cervical spine degeneration. PURPOSE: The aim of our study was to describe the changes in cervical IVDs and EPs with degeneration and to test the validity of the HDS in the cervical spine. STUDY DESIGN: A histological study on degenerative changes in cervical IVDs and EPs was conducted. METHODS: Thirty human cadavers were dissected to obtain 60 cervical IVDs from the lower half of C4 to the level of the upper half of C6. The IVDs were carefully excised along with EPs and then sectioned to obtain midsagittal samples for macroscopic examination according to a five-grade classification system. The samples were further dissected, fixed, and stained for histological examination according to HDS. RESULTS: Thirty C4-C5 IVDs and thirty C5-C6 IVDs were macroscopically examined for degeneration. The averaged Thompson's grade was found to be 2.9±1.3. The mean HDS for IVDs was 13.1±5.8 and for EP was 10.2±5.2. The interrater reliability estimates indicated excellent reliability (κ values>0.81, percentage agreement 86.1%-96.1%). Spearman's rank correlation coefficients for IVD and EP scores showed good consistency in predicting macroscopic degeneration. No significant differences were found between the values for cervical IVDs and EPs in the present study and those for lumbar discs derived in previous studies. CONCLUSIONS: The HDS was confirmed to be as accurate in predicting the degree of degeneration in the cervical spine as in the lumbar region. To our best knowledge, this is the first reported and validated histological classification system intended for assessing histological degeneration in the cervical spine. Therefore, HDS can be recommended for academic and pathologic purposes in cervical disc degeneration.

Validation of the Polish version of the EORTC Head and Neck module (QLQ-H&N35).

AIM: The aim of this study was to psychometrically validate the EORTC translated, Polish version of the EORTC QLQ-H&N35 questionnaire to support using it in the Polish clinical setting in patients with head and neck malignancies. MATERIALS AND METHODS: Patients with histologically confirmed head and neck malignancies were included in the study. All patients filled in the Polish version of the EORTC QLQ-C30, the EORTC QLQ-H&N35 module, and a demographic questionnaire. Standardized validity and reliability analyses were performed. RESULTS: During the recruitment period a total of 176 patients (82 females - 46.6%) were enrolled into the study, with a mean age of 54.3 ± 11.2 years. Cronbach alpha values ranged from 0.71 to 0.87. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. CONCLUSIONS: The Polish version of the EORTC QLQ-H&N35 module is a reliable and valid tool for measuring HRQoL in Polish patients with head and neck malignancies. It can be fully recommended for use in the Polish clinical setting.

Gastroscopy in patients with hiatal hernia with and without gastroesophageal mucosal prolapse.

There are still many doubts in the literature regarding gastroesophageal mucosal prolapse (GEMP) and its clinical course. We still do not know what determines mucosal wedging in esophagogastric junction, and what is the role of the anatomy of that site. To investigate that problem we performed 120 upper digestive tract endoscopies in which a hiatal hernia was diagnosed. Patients referred to our unit with different complaints most frequently of typical or atypical gastroesophageal (GE) reflux symptoms. The aim of that study was to assess hernia dimensions in patients with and without GEMP diagnosed during endoscopy. Additionally we analyzed the type and prevalence of gastrointestinal symptoms reported by patients to confirm the observation that GEMP symptoms differ from gastroesophageal reflux disease (GERD) symptoms. METHODS: One-hundred and twenty patients were included in this study. All of the patients were diagnosed with a hiatal hernia during routine gastroscopy. Using standardized methodology the region of the hiatal hernia was photographed, and hernia longitudinal and transverse dimensions were measured. RESULTS: The study group comprised 57 females (52.5%) and 63 males - mean age (SD) 58.5 ± 18.4. Most of the patients had standard GERD symptoms (n = 96; 80%). The average length of hiatus, in patients with GEMP (n = 24; 20%) was 3.56 ± 0.59 cm, and the average width was 2.32 ± 0.62 cm (n = 96; 80%) vs. 4.64 ± 0.74 cm and 2.98 ± 0.68 cm respectively in patients without GEMP (p <0.001). CONCLUSIONS: GEMP occurs in smaller sized hiatal hernias. We confirmed that disease symptoms of the majority of patients with GEMP differ from patient with GERD but without GEMP. However this difference was not significant enough to allow to differentiate between diagnoses based solely on the symptoms.

Age- and degeneration-related variations in cell density and glycosaminoglycan content in the human cervical intervertebral disc and its endplates.

The first aim of this study was to quantify cell density in cervical intervertebral discs (IVDs) and endplates of varying age and degeneration grade. The second aim was to analyze glycosaminoglycan (GAG) content in cervical IVDs and their endplates. Sixty cervical IVDs were excised from 30 human cadavers, not later than 24 hours post-mortem. Each sample underwent sectioning. Half of each sample underwent GAG content analysis using the dimethylmethylene blue binding assay. The other half underwent histological processing, histological degeneration grading, and cell density assessment using the Abercrombie method. The nucleus pulposus (NP) (4218 ± 417 cells/mm³) had significantly higher cell density than the anterior annulus fibrosus (AF) (3283 ± 438 cells/mm³; p < 0.0001), and similar cell density (4464 ± 551 cells/mm³; p = 0.36) to the posterior AF. Cell density was similar throughout the different regions of the endplate. The NP (619 ± 178 µg/mg dry weight) had a significantly higher GAG content than both the anterior (428 ± 199 µg/mg dry weight; p < 0.0001) and posterior AF (524 ± 218 µg/mg dry weight; p < 0.0001). In conclusion, this study introduces detailed 3D maps of cervical IVD and endplate cell density and GAG content. Furthermore, it shows that cervical IVDs and their endplates only slightly differ, in terms of cell density and GAG content, from lumbar IVDs.

Staphylococcus epidermidis and biofilm-associated neutrophils in chronic rhinosinusitis. A pilot study.

A key role of bacterial biofilm in the pathogenesis of chronic rhinosinusitis (CRS) with (CRSwNP) and without nasal polyps (CRSsNP) is commonly accepted. However, the impact of some bacterial species isolated from inflamed sinus mucosa on biofilm formation is unclear. In particular, the role of Staphylococcus epidermidis as aetiological agents of CRS is controversial. Moreover, the effect of biofilm formation on neutrophil infiltration and activity in CRSwNP calls for explanation. In this study, biofilms were found in three of 10 patients (mean age = 46 ± 14) with CRS undergoing endoscopic sinus surgery by means of scanning electron microscopy. Unexpectedly, S. epidermidis was the primary isolated bacteria and was also found to be present in all biofilm-positive mucosa specimens, indicating its pivotal role in the pathogenesis of severe chronic infections associated with biofilm formation. We have also measured the activity of myeloperoxidase (MPO), the most abundant neutrophil enzyme, to demonstrate the presence of neutrophils in the samples tested. Our present results show that the level of MPO in CRS associated with biofilm is lower than that without biofilm. It may suggest either a low number of neutrophils or the presence of a type of neutrophils with compromised antimicrobial activity, described as biofilm-associated neutrophils (BAN). Finally, we conclude that further studies with a large number of CRS cases should be performed to establish the association between S. epidermidis and other frequently isolated bacterial species from paranasal sinuses, with the severity of CRS, biofilm formation and the infiltration of BAN.

Degeneration and calcification of the cervical endplate is connected with decreased expression of ANK, ENPP-1, OPN and TGF-ß1 in the intervertebral disc.

The aim of this study was to clarify the relationship between the expression of ALP, ANK, ENPP-1, OPN and TGF-ß1 in the intervertebral disc (IVD), and cervical vertebral endplate calcification and degeneration. Sixty cervical IVDs were excised from 30 human cadavers. Each cadaver was assessed macroscopically for degeneration (Thompson's classification), and then underwent histological processing, regular staining (hematoxylin and eosin, Masson-Goldner trichrome and alcian blue-PAS), immunohistochemistry (ALP, ANK, ENPP-1, OPN and TGF-ß1), microscopic degeneration grading (Boos classification), and assessment of endplate calcification. The mean age ± SD of the cadavers was 51.4 ±19.5. The percentage of endplate calcification significantly correlated with the degree of endplate and IVD degeneration graded using Boos's score (both r = 0.91; p < 0.0001). The intensity and number of stained cells per FOV markedly decreased, for ANK, ENPP-1, and TGF-ß1, with the grade of IVD degeneration, regardless of the analyzed IVD region. This was not true only for ALP, which demonstrated an increasing trend corresponding to the degree of IVD degeneration. The expression of OPN was low throughout all analyzed regions, regardless of the degree of degeneration. Modulating the expression of the abovementioned proteins, especially ANK and TGF-ß1, may be a new way to prevent degeneration and calcification of the IVD.

Validation of the Polish version of the EORTC QLQ-BM22 module for the assessment of health-related quality of life in patients with bone metastases.

PURPOSE: The aim of our study was to undertake a prospective validation study of the Polish version of the European Organization for Research and Treatment of Cancer (EORTC) bone metastases (QLQ-BM22) module used alongside the EORTC core measure. METHODS: The translated module was pilot-tested according to the established EORTC guidelines. Patients with histological confirmation of malignancy and bone metastases, diagnosed by imaging studies, were eligible for the study. All patients filled out the Polish version of the QLQ-BM22 module in addition to QLQ-C30 and a demographic questionnaire. Standard validity and reliability analyses were performed. RESULTS: One hundred and fifty-five patients were enrolled into the study, including 94 women (60.7 %) and 61 men (mean age ± SD; 59.1 ± 12.1). Cronbach's alpha coefficients, range 0.68-0.93, showed positive internal consistency. Re-test was undertaken with fifty patients (32.3 %). Interclass correlations for the EORTC QLQ-BM22 ranged from 0.91 to 0.93 and proved sufficient test-retest reliability. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. CONCLUSIONS: Our study provides new and robust evidence which shows that the Polish version of the QLQ-BM22 module is a valid and reliable instrument for measuring health-related quality of life in patients with bone metastases. It is suitable for use in clinical trials and in research.

The influence of bacterial biofilm on the clinical outcome of chronic rhinosinusitis: a prospective, double-blind, scanning electron microscopy study.

The aim of this study was to assess the influence of bacterial biofilms in chronic rhinosinusitis (CRS) patients on the clinical outcomes following endoscopic sinus surgery (ESS). This was a prospective, double-blind study. Patients undergoing ESS, because of CRS, were recruited. Overall 80 patients were qualified. For each of these demographic, clinical and radiologic characteristics were recorded. During surgery each patient had at least 7 mucosal specimens taken to assess, using scanning electron microscopy, the possible presence of bacterial biofilms. Prior to mucosa specimen excision, swabs for bacteriological and fungal analyses were taken. Each patient underwent perioperative and follow-up assessment at 3 and 6 months post-ESS. Biofilms were found in 33 (41.3%) patients (study group). From among the 47 patients without the presence of biofilms, 33 (control group) were taken to match the study group in age, gender and clinical characteristics. The intensity of subjective and objective CRS symptoms, as well as patient quality-of-life, did not correlate with the Lund and Mackay score (p > 0.05). Analysis of variance showed that, in the control group or the group as a whole, the intensity of subjective and objective symptoms decreased (p < 0.05), and the quality-of-life increased with time (p < 0.05). In conclusion, biofilm-positive patients tend to have a greater severity of disease preoperatively and continue to have persistent and more severe symptoms post-ESS. This study supports the role of biofilms in maintaining the chronic and recalcitrant nature of CRS. The lack of planktonic bacteria in post-operative sinus swabs does not rule out the presence of bacterial biofilms.

Knowledge on the subject of human physiology among Polish high school students--a cross-sectional study.

BACKGROUND: In most cases the only knowledge an individual will receive with regards to their own body and its proper functioning is during their high school education. The aim of this study was to evaluate high school students' knowledge about basic physiology. MATERIAL AND METHODS: The research was carried out in five, randomly chosen high schools in Krakow, Poland. Young people in the age of 17-19 years were asked to fill in the questionnaire designed by the authors. The first part of the survey included personal data. The second part contained 20 close-ended questions assessing students' knowledge about the basics of human physiology. Question difficulty varied from easy through average, and up to difficult. The maximum number of points to achieve was 20. RESULTS: One-thousand-and eighty-three (out of 1179 invited--91.86%) Polish high school students (63.25% female) filled in a 20-item questionnaire constructed by the authors regarding basic human physiology. The mean age of the group was 17.66 ± 0.80 years. The mean score among the surveyed was 10.15 ± 3.48 (range 0-20). Only 26.04% of students achieved a grade of 60% or more, and only one person obtained the highest possible score. Females achieved significantly better scores than males (10.49 ± 3.38 vs. 9.56 ± 3.56; p < 0.0001). Pupils in their second year who were in the process of studying physiology, obtained better results than those in their third year who had already finished the biology course (10.70 ± 3.27 vs. 9.81 ± 3.74 respectively; p < 0.0001) and those in their first year who did not yet study human physiology (10.70 ± 3.27 vs. 9.63 ± 2.74 respectively; p = 0.003). Over 23% of students did not know that mature red blood cells do not have cell nuclei and a similar number of them answered that humans have 500,000 erythrocytes in 1 mm3 of blood. Over 32% believed that plasma does not participate in the transport of respiratory gases, and 31% believed that endocrine glands secrete hormones within their immediate vicinity and into the blood. CONCLUSIONS: Our research has shown that young people, especially men, often lack basic physiological knowledge needed to make conscious and responsible decisions regarding their health. Our results suggest that more emphasis should be put on properly teaching human physiology in high school, especially to those students who do not plan a career in medicine-related fields. This study brings to light the disturbing fact that about a year after a student finishes his basic physiology course his knowledge of the subject returns to a pre high school level.

A novel in-vitro model of human aortic valve mineralization.

BACKGROUND AND AIM OF THE STUDY: The study aim was to develop an in-vitro model of human aortic valve homograft (AVH) mineralization, as a basis for further research on the subject of calcific aortic valve disease (CAVD). METHODS: Human aortic valves were excised during autopsy (12-24 h post-mortem) from donors who had died due to accident or suicide. The mean (±SD) donor age was 32.5 ± 11.4 years. Under sterile conditions each aortic cusp (three cusps per valve) was cut in half to provide a total of 240 tissue samples. AVH mineralization was assessed in solutions with different Ca and P concentrations and CaxPO4 ionic product values. The impact of time on aortic valve mineralization rate was assessed using energy-dispersive X-ray fluorescence (ED-XRF). RESULTS: The model showed that human AVH mineralization can be best observed in a solution with a CaxPO4 ionic product of 2.2 mmol2/l2. The optimum incubation time for observing AVH mineralization was 21 days. CONCLUSION: A novel in-vitro AVH mineralization model was developed for use in future studies.

Preliminary psychometric validation of the Polish version of the EORTC head and neck module (QLQ-H&N35).

AIM: The aim of our study was to report preliminary validation data on the EORTC translated, Polish version of the EORTC QLQ-H&N35 questionnaire to show that this tool is an acceptable and psychometrically robust measure to collect HRQoL data in Polish patients with head and neck malignancies. MATERIALS AND METHODS: Patients with histological confirmation of head and neck malignancies were eligible for the study. All patients filled out the Polish version of the EORTC QLQ-H&N35 module in addition to EORTC QLQ-C30 and a demographic questionnaire. Standardized validity and reliability analyses were performed. RESULTS: Fifty-one patients (23 females - 45.1%) were enrolled into the study, with a mean age of 51.3 ± 12.9 years. Cronbach alpha coefficients, range 0.72-0.85, showed positive internal consistency. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. CONCLUSIONS: Basing on the preliminary data from this report, one can say that the Polish version of the EORTC QLQ-H&N35 module is a reliable and valid tool for measuring HRQoL in patients with head and neck malignancies. However further research is needed to establish the full psychometric properties of the described module, especially test-retest and responsiveness over time.

[Biofilm from patients with chronic rhinosinusitis. Morphological SEM studies]. / Biofilm w przebiegu przewleklego zapalenia zatok przynosowych. Badania morfologiczne w SEM.

INTRODUCTION: Bacterial biofilm is a three-dimensional structure made of aggregates of bacterial cells (microcolonies) and the extra cellular matrix released by them, adhering to organic and inorganic surfaces. It is estimated that 99% of all bacteria exist in biofilms, and only 1% live in a free-floating or planktonic state at any given time. The aim of the study was to demonstrate biofilms in mucosal specimens of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis and co-occurrence of such illnesses as nasal polyps, bronchial asthma, NSAIDs allergy, and aspirin-induced asthma. MATERIAL AND METHODS: A prospective study of 25 patients suffering from chronic rhinosinusitis. All patients underwent completed a otolaryngological examination and paranasal sinus CT scans. Endoscopic surgery of nasal sinuses (ESS) was performed in all patients. The mucous membrane samples were taken from the inside of the sinus and concha bullosa. They were prepared and examined with a scanning electron microscope (SEM). The images were then compared with the available database of the biofilm images. RESULTS: Using SEM morphologic criteria, the biofilms were identified in the studied material in nineteen patients (83%). In four patients with chronic rhinosinusitis, no biofilms were found on the samples taken. A bacteriological examination of smears from inside of the sinus, revealed the presence of various types of bacteria. In two patients no bacteria was found in the smears. CONCLUSIONS: It is supposed that bacterial biofilms perform an essential role in the pathogenesis of chronic sinusitis. One may speculate that, the presence of biofilms in patients with chronic rhinosinusitis could induce the co-occurrence of such illnesses as nasal polyps, bronchial asthma, aspirin-induced asthma or a NSAIDs allergy. In order to evaluate better the role of biofilms in chronic rhinosinusitis, it seems justified to extend the research to a larger group of patients and a control group.

[Endoscopic management of osteomas of the paranasal sinuses--own experience]. / Endoskopowe leczenie chorych z kostniakami zatok przynosowych--doswiadczenie wlasne.

Osteomas are relatively common, benign, slow-growing, often asymptomatic neoplasms of the paranasal sinuses, occurring mainly in frontal and ethmoid sinuses. Surgical removal is done if they extend beyond the boundaries of the sinus, keep enlarging, are localised in the region adjacent to the nasofrontal duct, or if signs of chronic sinusitis are present and, irrespective of their size, in symptomatic tumours. Progressive headaches and chronic inflammation of the adjacent mucous membrane are most common symptoms. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas. Aim. The aim of the paper was to report own experience in endoscopic treatment of patients with osteomas of the paranasal sinuses. Material and methods. 6 patients with osteomas of paranasal sinuses were included in the group, mean age 36 years (range 15-52). Most common involvement was ethmoid cells (3). There were also patients with frontal, maxillary and sphenoid osteoma. All tumours were removed under endoscopic giudance. Frontoethmoidectomy was performed to remove ethmoid and frontal osteomas. Antrotomy was used in case of maxillary involvement and sphenoethmoidectomy in the patient with sphenoid sinus osteoma. Sphenoid sinus was approached through its anterior wall with a Stammberger punch. All the tumours were removed using fine forceps. Results. No post-operative complications were observed. No recurrences were noted. All patients remain asymptomatic. Conclusions. Resection of small and medium size osteomas of the paranasal sinuses can be safely and radically performed using endoscopic techniques. It allows their radical resection and very good cosmetic effects.

[Endoscopic surgical treatment of patients with isolated sphenoid sinus disease]. / Endoskopowe leczenie chorych z izolowanymi stanami patologicznymi zatoki klinowej.

INTRODUCTION: Cases of isolated lesions of the sphenoid sinus are rare. For descriptive purposes, clinicians divide them into inflammatory and non-inflammatory with prevalence of the former. Symptoms of the sphenoid sinus disease are difficult to characterise, the most common of them being vague headache and visual disturbances. Thorough preoperative evaluation of the lesion is essential - nasal endoscopy must be performed and computerised tomography or magnetic resonance imaging results analysed. The purpose of the study is to present the assessment of endoscopic surgery outcome in the own group of patients with isolated sphenoid disease. MATERIAL AND METHODS: Clinical data of 22 subjects were analysed retrospectively. There were 5 patients with bacterial sinusitis, 6 with fungal sinusitis, 4 with allergic thickening of the mucous membrane with no evidence of bacterial or fungal infection, 2 with mucocele, 1 with sphenoid osteoma, 1 with inverted papilloma, 1 with a foreign body and 2 with cerebral fluid fistula. Each patient had preoperative nasal endoscopy and CT/MRI imaging performed. Then they underwent endoscopic transnasal sphenoethmoidectomy with removal of the lesion or closure of the fistula. The sphenoid sinus was approached through its front wall. RESULTS: The patients' postoperative course was uneventful. They noted improvement in all preoperative symptoms, except for bilateral oculomotor nerve paralysis in one individual, and were asymptomatic to ophthalmological examination. CONCLUSIONS: Isolated lesions of the sphenoid sinus, even very rare tumours like those presented here, can be in most cases safely approached and removed endoscopically. All risks of the method must be considered prior to the operation. High frequency of fungal sinusitis should be noted.

[Endoscopic treatment of patients with intracranial complications of sinusitis]. / Endoskopowe leczenie chorych z wewnatrzczaszkowymi powiklaniami zapalenia zatok.

INTRODUCTION: Intracranial complications of sinusitis (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and current topic. Although they are nowadays relatively rare, prompt recognition of these disease states is important to prevent permanent neurological deficit or fatality. Infection may spread hematogenously or by direct extension. Patients with complications require surgery to remove the focus of infection from the sinuses and drain the abscess. Recently, endoscopic frontal and sphenoid sinus surgery has emerged as the preferred technique for the treatment of the most advanced and complicated chronic sinusitis. MATERIAL AND METHODS: Records of 7 patients aged from 13 to 65 (mean 30.6) years treated in our department for intracranial complications between January 2002 and September 2006 were analysed retrospectively. The diagnosis of meningitis was established in 2 patients, in one case with accompanying bilateral oculomotor nerve palsy. Cavernous sinus thrombosis, frontal abscess with hemiplegia, cerebral oedema, bilateral oculomotor nerve palsy and retrobulbar optic nerve neuritis with blindness was diagnosed each in one individual. 5 endoscopic bilateral frontosphenoethmoidectomies and 2 endoscopic sphenoethmoidectomies were performed. In one case a frontosphenoethmoidectomy was combined with craniotomy. RESULTS: All preoperative symptoms subsided in 4 operated individuals. Vision improved in the patient with bilateral retrobulbar optic nerve neuritis. In patients with hemiplegia and bilateral oculomotor nerve palsy the symptoms persisted. No complications of the surgery were observed. CONCLUSIONS: Surgical treatment of the focus of infection in the sinuses can be accomplished endoscopically via an intranasal approach with less morbidity, easy identification of anatomical structures, physiological drainage of the sinuses and superior cosmetic effects.