Geographic variation in allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) has a worldwide distribution. This survey of 20 otolaryngologic practices throughout the United States confirmed a variation in the frequency of AFRS relative to endoscopic sinus procedures performed for all other diagnoses. The highest incidence occurred in Memphis, Tennessee at 23%, with three other southern practices reporting a frequency of at least 10%. In the northern locations the frequency ranged from 0 to 4%. No correlation with mould counts was demonstrated, possibly because of incomplete mould data relative to most of the surgical locations.

Acute invasive sinusitis due to Trichoderma longibrachiatum in a liver and small bowel transplant recipient.

We describe a case of acute invasive sinusitis due to an unusual moniliaceous fungus, Trichoderma longibrachiatum Rifai 1969 (a member of the class Hyphomycetes), in a small bowel and liver transplant recipient treated with tacrolimus (FK-506) and prednisone. The patient was successfully treated with surgical debridements and amphotericin B followed by oral itraconazole.

Unilateral trigeminal nerve branch lesion (V1 and V2) at the skull base and nasal capsule growth in rabbits.

The effects of long-term afferent denervation on midfacial and nasal capsule growth after craniofacial or skull base surgery are unknown. Experimental studies suggest that afferent nerves may play a role in regulating craniofacial growth through neurotrophic influences. The present study was designed to assess the effects of nasal capsule afferent (V1 and V2) denervation on nasal capsule growth in the rabbit. Eighteen 1 1/2-week-old rabbits were evenly divided into three groups: unoperated controls, sham controls, and animals with unilateral anterior ethmoid and sphenopalatine nerve lesions. The nerves were lesioned at the skull base with electrocautery through an intraorbital approach at 1 1/2 weeks of age. Lateral head radiographs and dental study models were taken at 1 1/2, 3 1/2, 6, and 12 weeks of age. By 3 1/2 weeks of age, sham controls and animals with nerve lesions exhibited significant (p < 0.05) reductions in nasal capsule area and height compared with unoperated control animals; the lesioned animals were more severely affected. However, by 6 weeks no differences were noted between the sham and lesioned groups, which were both smaller than unoperated controls through 12 weeks of age. Results suggest that acute nasal capsule growth deficits are a consequence of surgery as well as afferent denervation, with a greater deficit in the latter group, possibly through neurotrophic interruption. Such deficits may not be a permanent effect in the rabbit model.

Sources of error in use of beta-2 transferrin analysis for diagnosing perilymphatic and cerebral spinal fluid leaks.

Beta-2 transferrin is a protein found in cerebral spinal fluid and inner ear perilymph, but not in blood, nasal, or ear secretions. The clinical use of this test has been previously demonstrated, but sources of test error have not been addressed. The purpose of this study was to evaluate sources of error related to this test in order to improve its clinical use. We reviewed the specimens submitted for beta-2 analysis over the first 12 months of test availability at our institution to identify potential factors leading to test error. Sources of error were categorized into the following groups: sample collection, delivery, and extraction factors; assay factors; physician-related factors; and patient-related factors. The test for beta-2 transferrin is a valuable diagnostic tool for the management of difficult clinical problems, provided the physician is aware of potential factors that can lead to test error and clinical mismanagement.

Beta-2 transferrin assay in clinical management of cerebral spinal fluid and perilymphatic fluid leaks.

Beta-2 transferrin is a protein found in cerebral spinal fluid (CSF) and inner ear perilymph, but not in blood, nasal or ear secretions. The purpose of this paper is to evaluate the clinical usefulness of the current assay for beta-2 transferrin for detecting CSF and perilymphatic leaks. We reviewed the hospital records of the first 88 patients having specimens submitted for beta-2 transferrin analysis at our institution. Both CSF and perilymph leaks were identified. However, confirmation of the absence or presence of beta-2 transferrin was directly used in the clinical management of only 55% of the patients. This was largely secondary to the time delay in test processing and initial lack of physician confidence with the test. However, our review of the clinical outcomes relating to the use of the beta-2 transferrin analysis suggests high sensitivity and specificity for the test. Analysis of beta-2 transferrin appears to be a valuable test for detecting CSF leakage and a promising test for confirming perilymphatic leaks. However, to achieve greater clinical usefulness a rapid clinical assay needs to be developed and further information gained regarding the sensitivity and specificity of the beta-2 transferrin assay for detecting CSF and perilymphatic fluid leakage.

Rigid bronchoscopy balloon catheter dilation for bronchial stenosis in infants.

Stenosis of the tracheobronchial tree can be a life-threatening problem. Management options for symptomatic stenosis include serial dilation, cryotherapy, laser resection, and open surgical correction. Recently, balloon angioplasty catheters have been used to dilate stenotic airway segments. The experience in infants is limited and has for the most part utilized guide wires and fluoroscopy for balloon placement. We present two infants with symptomatic bronchial stenosis who underwent endoscopic angioplasty balloon catheter dilation. Operative technique involved catheter placement under direct vision with a rigid bronchoscope. Catheters (6F) with 8-mm-diameter balloons were used. Balloon expansion was controlled with a hand-held manometer. Both infants demonstrated significant lumen size improvement intraoperatively and marked clinical improvement postoperatively, substantiated by endoscopy and radiographs. One infant has required one repeat dilation and has subsequently been asymptomatic. The other infant has had no further respiratory problems. Our technique, using a rigid bronchoscope with direct visualization of catheter placement, obviates the need for guide wires and C-arm fluoroscopy as previously described. Endoscopic placement enables direct visualization of balloon position, and fine adjustments are possible if further dilation is necessary. Rigid bronchoscopic balloon catheter dilation can be a successful technique for bronchial stenosis and should be considered prior to attempting more invasive surgical correction.

Subperiosteal orbital abscess in children: diagnosis, microbiology, and management.

A chart review was undertaken of 30 patients who were presented to Children's Hospital of Pittsburgh from 1983 to 1990 and underwent surgical management for suspected subperiosteal abscess of the orbit (SPA). All patients had preoperative computerized tomography (CT) scans. Twenty-seven of 30 CT scans were reevaluated, of which 20 (74%) demonstrated findings consistent with or suggestive of SPA. Opacified sinuses were seen in 100% of this study group. Abscess collections were found in 21 patients (70%). Predominant organisms included: Streptococcus pneumoniae (38%), Streptococcus pyogenes (33%), and Haemophilus influenzae (14%); Moraxella catarrhalis was not isolated and anaerobic bacteria were isolated from only one patient. CT scans were found to be accurate predictors of SPA in 16 (80%) of 20 patients. All patients did well following surgical intervention without visual or central nervous system sequelae. We conclude from this study that CT scans should be obtained when SPA is suspected, and antimicrobial therapy should be directed toward the bacteria isolated from these abscesses.

Chondritis of the burned ear: a review.

Seventy-six patients with burns of the ears presented to the Western Pennsylvania Hospital Burn Trauma Center over a three year period. To prevent chondritis, all ears were treated prophylactically with periauricular hair shaving, daily cleaning, avoidance of pressure dressings and Sulfamylon Burn Cream. Chondritis developed in two patients. Aspects of auricular chondritis prevention and treatment are reviewed. Biology of the disease is discussed.

Temporal sequence of motor disturbances and increased cerebellar glutamic acid decarboxylase activity following 3-acetylpyridine lesions in adult rats.

Adult male rats were administered 75 mg/kg of the neurotoxin 3-acetylpyridine to produce lesions of the inferior olive-climbing fiber projection to the cerebellum. At selected times ranging from 6 h to 43 days postlesion, rats were evaluated for motor dysfunction, and glutamic acid decarboxylase (GAD) activity was determined in the deep cerebellar nuclei and cerebellar vermis. In the deep nuclei non-monotonic changes in GAD activity were found following climbing fiber destruction. Initially, there was a steady increase in GAD activity which peaked at 38% above control values 14 days postlesion. GAD activity then slowly declined, although it remained significantly above control levels at 43 days postlesion, the latest time point examined. In the vermis, GAD activity was significantly increased at 4 days postlesion (+8%) and remained at approximately this level throughout the experiment. The initial behavioral effects of climbing fiber loss included hypotonia and ataxia with severely reduced mobility. With time, the ataxia and hypotonia decreased and movements such as mud-walking and pivoting developed. As these behaviors diminished, other novel conditions such as movement-associated tremor and hopping appeared. These results are discussed in the context of the previously reported effects of climbing fiber lesions on the firing rates of Purkinje cells and deep nuclei cells.