Transnasal puncture based on echographic sinusitis evidence in mechanically ventilated patients with suspicion of nosocomial maxillary sinusitis.

OBJECTIVE: The aim of this prospective study was to evaluate the value of sinus echography results to directly indicate a transnasal puncture in intubated patients with suspicion of nosocomial maxillary sinusitis. DESIGN: prospective clinical investigation. SETTING: medical intensive care unit. PATIENTS: sixty patients undergoing intubation and mechanical ventilation more than 2 days, with a clinical suspicion of maxillary sinusitis with purulent nasal discharge. INTERVENTIONS: 120 sinuses were examined by sinus ultrasound. The image defined as normal was an acoustic shadow arising from the front wall. Two levels of positive echography were described: (1) a partial sinusogram was defined as the visualization of the hyperechogenic posterior wall of the sinus; and (2) a complete sinusogram was defined as the hyperechogenic visualization of posterior wall and the extension by the internal and external walls of the sinus. When sinus ultrasound was positive, a transnasal puncture was performed the same day. The transnasal puncture was positive if a fluid was obtained from sinus aspiration. The transnasal puncture was negative if there was no aspirated material. MEASUREMENTS AND RESULTS: sinus ultrasound was positive in 84 cases (54 complete sinusograms and 30 partial sinusograms). Seventy-eight of 84 transnasal punctures were positive. Sensitivity of a sinusogram for obtaining positive transnasal puncture was 100%, and specificity was 86% (100% in case of complete sinusogram) in a clinically selected population. The only six negative transnasal punctures were performed in patients with partial sinusogram. CONCLUSIONS: Ultrasound sinusitis evidence seems to be of value to indicate and perform a transnasal puncture directly, avoiding CT exam.

Radiolocalização do linfonodo sentinela em portadores de carcinoma espinocelular da cavidade oral e orofaringe: resultados preliminares / Sentinel Lymph node radiolocalization in cancers of the oral cavity and oropharynx: preliminary results

Objetivos: Avaliar a eficácia e a utilidade do estudo por radiolocalização do linfonodo sentinela em portadores de carcinoma espinocelular de orofaringe e cavidade bucal. Foi estudado o comportamento radioativo do linfonodo sentinela no paciente (in vivo) e fora deste (ex vivo) e a histologia do linfonodo sentinela comparado com os achados histológicos do esvaziamento cervical ipsilateral. Métodos: Utilizou-se 12 pacientes com tumores de orofaringe e cavidade bucal tratados na Clinique Saint Augustin - Bordeaux - França no período de janeiro a dezembro de 2003. A radiolocalização do linfonodo sentinela foi realizada com injeção peritumoral de tecnécio 99m, análise no laboratório de cintilografia e utilização da sonda gama no per-operatório. Os linfonodos radiomarcados foram comparados por sua atividade radioativa in vivo e ex vivo e, com o restante do esvaziamento cervical, quanto à característica histopatológica. Resultados: Em relação à comparação do comportamento radioativo in vivo e ex vivo, existiram 15 zonas radiomarcadas e, entre estas, cinco zonas não coerentes in vivo e ex vivo. A comparação da histologia do linfonodo sentinela e o restante do esvaziamento cervical mostram coerência em nove casos e discordância em três. Conclusão: Os resultados sugerem que a técnica de radiolocalização de linfonodo sentinela em portadores de carcinomas espinocelulares de orofaringe e cavidade bucal é pouco eficaz tanto para determinar corretamente o linfonodo sentinela quanto para predizer o estado dos demais gânglios do esvaziamento cervical.