The efficacy of functional endoscopic sinus surgery in the evolution of fever of unknown origin in ICU patients.

CONCLUSION: Functional endoscopic sinus surgery (FESS) was found to be effective in treating fever of unknown origin (FUO) in intensive care unit (ICU) patients with rhinosinusitis, with 62% of patients showing improvement within 5 days of the procedure. OBJECTIVE: To correlate improvement in FUO with FESS drainage of the paranasal sinuses. METHODS: Fifty patients that developed FUO during ICU stay, with CT findings suggestive of rhinosinusitis, and showed no improvement in fever after clinical treatment underwent FESS for drainage of the paranasal sinuses and were evaluated for postoperative improvement of fever. RESULTS: The study sample consisted of 50 patients (74% of whom were male, mean age 48.1 years). The most frequent diagnoses at ICU admission were tetanus, pulmonary disease, and cardiovascular disease. In all, 68% of patients underwent nasogastric or enteral intubation. CT scanning most commonly showed involvement of the sphenoid sinus. In 54% of cases, sinusitis was bilateral and extended throughout the maxillary, ethmoidal, and sphenoidal sinuses. Sinusectomy was performed in all patients, and pathological secretion in the paranasal sinuses was seen in 52% of patients during surgery. Gram-negative bacteria were the most commonly isolated organisms, followed by Gram-positive bacteria and fungi. Improvement of fever was found in 82% of patients after FESS; 38% of these improved within the first 48 h post-procedure, and the remaining 62% within the first 5 postoperative days.

Severe posterior epistaxis-endoscopic surgical anatomy.

OBJECTIVE: To describe the anatomy of the sphenopalatine foramen (SPF) region and possible anatomical variations. STUDY DESIGN: Prospective study accomplished from September, 2006, to January, 2007. METHODS: The sphenopalatine foramen (SPF) of 61 cadavers were carefully dissected. Presence of the ethmoidal crest, location of sphenopalatine and accessory foramens, and the number of arterial branches emerging through foramens were observed. Data were analyzed in relation to gender, racial group, and symmetry of the cadaver. Prediction of the presence of accessory foramen was evaluated. RESULTS: Mixed race cadavers prevailed in 122 nasal fossae dissected (75% males). Ethmoidal crest was present in 100% of the cadavers, being anterior to the SPF in 98.4% of the cases. The most frequent SPF location was the transition of the middle and superior meatus (86.9%). Mean distance from the SPF and accessory foramen to anterior nasal spine was 6.6 cm and 6.7 cm, respectively. Accessory foramen was present in 9.83% of the cases. A single arterial stem emerged through the SPF in 67.2% of the cases, and 100% through accessory foramens. The prevalence analyses showed no differences that were statistically significant (P > 0.05) between gender and racial group. The symmetry analyses showed a strong conformity (P < 0.01) between nasal fossae in relation to the SPF location. There was no statistically significant conformity between nasal fossae and accessory foramen (P = 0.53). None of the variables of interest presents any statistically significant (P > 0.05) association with the presence of the accessory foramen. CONCLUSIONS: There are anatomical variations in the lateral nose wall that should be considered for successful endoscopic surgical treatment of severe epistaxis.

Expressão da molécula de adesão VCAM-1 em pacientes com polipose nasal / The expression of VCAM-1 adhesion molecule in patients with nasal polyposis

Objetivo: Estudar a expressão da molécula de adesão VCAM-1 em endotélio vascular na migração eosinofílica de pacientes com polipose nasal. Métodos: Foram selecionados prospectivamente 39 pacientes com polipose nasal, sendo 13 considerados alérgicos e 26 não-alérgicos, além de um grupo controle com onze indivíduos. A pesquisa da expressão de VCAM-1 foi realizada por imunohistoquímica em tecido congelado.Resultados: Houve maior incidência de polipose nasal após a quarta década de vida e no sexo masculino. 0 quadro clínico foi semelhante nos dois grupos e se caracterizou principalmente por obstrução nasal e hiposmia. A expressão de VCAM-1 foi significativa nos dois grupos de com polipose nasal, sugerindo que esta molécula de adesão possivelmente está envolvida na intensa migração de eosinófilos que ocorre nesta doença. Conclusão: A expressão de VCAM-1 foi significamente maior nos pacientes com polipose nasal,independentemente de haver ou não alergia, sugerindo que esta molécula de adesão possivelmente está envolvida na intensa migração de eosinófilos que ocorre nesta doença.

Rinossinusite esfenoidal aguda e acometimento do terceiro par craniano: relato de caso e revisão de literatura / Acute sphenoid rhinosinusitis and third cranial nerve involvement: case report and review of the literature

O seio cavernoso encontra-se adjacente ao seio esfenoidal e apresenta íntima relaçäo com a artéria carótida interna e os nervos abducente, troclear, oculomotor e ramo oftálmico do nervo trigêmio. Como a parede do esfenóide é muito fina, o envolvimento de estruturas adjacentes se torna mais freqüente e perigoso quando este seio está acometido. O objetivo dos autores é relatar um caso de rinossinusite aguda complicada com o acometimento isolado de III par craniano e revisäo da literatura. Paciente do sexo feminino, 53 anos, com cefaléia frontal há 30 dias antes da internaçäo. Evoluiu com ptose palpebral esquerda associada à diplopia tendo sido diagnosticado acometimento isolado do nervo oculomotor secundário a uma rinossinusite esfenoidal aguda. Foi internada com antibioticoterapia endovenosa e submetida a cirurgia endoscópica dos seios paranasais, evoluindo com resoluçäo total do quadro. A falha no diagnóstico acurado e no tratamento da rinossinusite esfenoidal pode levar a graves seqüelas neurológicas, sendo que o tratamento precoce e agressivo é crucial para a prevençäo de complicaçöes desastrosas. Em nossa experiência, a cirurgia endoscópica dos seios paranasais vem demonstrando ser uma abordagem segura e eficaz no tratamento das complicaçöes de rinossinusites agudas